Adverse reactions
Data klinis
Iwan Dwiprahasto
Dept of Pharmacology & Therapy FK UGM Biaya
Titer Konsentrasi
Bactericidal vs. For aminoglycosides: peak to MIC
bacteriostatic
Synergy bakterisidal dalam serum &
serum jaringan ratio > 10
C.inc
C.clos
Gagal/tidak melakukan
pemeriksaan apus
BMJ 1998;317:6524
Inappropriate Antimicrobial Therapy:
Prevalence among Intensive Care Patients
45.2%
50%
Inappropriate
34.3% Antimicrobial Therapy
40%
(n = 655 ICU patients with infection)
30%
Community-onset infection
17.1%
20% Hospital-onset infection
Hospital-onset infection after
10% initial community-onset infection
0%
Proportion of S aureus isolates resistant to methicillin recovered from clinical Patient Group
specimens of inpatients in selected European countries. Data for hospitals are
derived from Voss et al,4 and data for intensive care units from Vincent et al5
Kollef M, et al: Chest 1999;115:462-74
Antimicrobial resistance S. pneumoniae CDC NNIS Insidensi VRE
Time Trends (Thomas et al., 2002)
30
80 25,6
ICU Non-ICU 23,9
21,8
60
20
15,4
40 12,812
11,5
10
20
5,3 4,8
2,9
0 0,40,3
1993 1994 1995 1996 1997 1998 1999 2000 2001 0
89 91 93 95 97 99
Penicillin Chloramphenicol Cotrimox
(www.cdcgov/ncidod/hip/NNIS/AR Surv1198.htm.)
ANTIBIOTIC STEWARDSHIP
Balancing adequate coverage with reducing
STRATEGIES ???????? emergence of resistance
STEWARDSHIP memerlukan Tools for good antibiotic stewardship
Mengupdate
Mengupdat e pengetahuan tentang
1. Guidelines
prevalence bakteri lokal
2. Restrictions
Mengupdate pola resistensi bakteri
Mengupdate
thd antibioti
antibiotika
ka 3. Area specific practices eg: ICU/NICU/HDU
1. Guidelines GUIDELINE-use_of_antibiotics_in_paed_care.pdf
Antibiotic guideline
Hospital drug formulary untuk antiinfeksi;
Pendidikan dan regulasi peresepan;
Pemantauan dan audit penggunaan obat;
Surveillance dan sistem pelaporan pola resistensi
hospital flora;
Deteksi pasien yang terkolonisasi communicable
resistant bacteria
Promosi dan monitoring praktek pengendalian
infeksi di rumahsakit seperti hand hygiene.
3. Area specific practices eg: ICU/NICU/HDU 4. CombinationTx
Synergism
2 possible scenarios
5. Antibiotic or Crop cycling/ rotation
Antibiotic cycling a
viable option for good
antibiotic stewardship
(crop rotation)
Unrestricted usage by Implement an
each specialist where antibiotic cycling/
any antibiotics may be
rotation policy
chosen at any times.
Prevent transmission
Johann Wolfgang von Goethe.
Clinicians hold the solution!