Treatment plan for

antimicrobial resistance
patients
Controlling the use of antibiotics is carried out by grouping antibiotics
into the AWaRe categories: ACCESS, WATCH, and RESERVE. This
grouping aims to facilitate the application of antibiotic stewardship at
the local, national and global levels; improve treatment results;
suppress the emergence of resistant bacteria; and maintain the efficacy
of antibiotics in the long term.
 Antibiotik kelompok ACCESS: Antibiotik kelompok WATCH
1. Tersedia di semua fasilitas pelayanan 1. Tersedia di fasilitas pelayanan kesehatan
kesehatan. tingkat lanjut.
2. Untuk pengobatan infeksi bakteri yang 2. Digunakan untuk indikasi khusus atau
umum terjadi. ketika antibiotik kelompok ACCESS
3. Diresepkan oleh dokter, dokter gigi, tidak efektif.
dokter spesialis, dan dikaji oleh apoteker. 3. Kelompok ini memiliki kemampuan
4. Penggunaan sesuai dengan panduan lebih tinggi dan berpotensi menimbulkan
praktik klinis dan panduan penggunaan resistensi sehingga diprioritaskan sebagai
antibiotik yang berlaku. target utama program pengawasan dan
pemantauan.
4. Diresepkan oleh dokter spesialis, dokter
gigi spesialis, dikaji oleh apoteker, dan
disetujui oleh dokter konsultan infeksi;
Antibiotik kelompok RESERVE
1. Tersedia di fasilitas pelayanan kesehatan
tingkat lanjut. 2.
2. Antibiotik kelompok ini dicadangkan
untuk mengatasi infeksi bakteri yang
disebabkan oleh MDRO dan merupakan
pilihan terakhir pada infeksi berat yang
mengancam jiwa.
3. Menjadi prioritas program pengendalian
resistensi antimikroba secara nasional
dan internasional yang dipantau dan
dilaporkan penggunaannya.
4. Diresepkan oleh dokter spesialis dan
dokter gigi spesialis, dikaji oleh
apoteker, dan disetujui penggunaannya
oleh tim Penatagunaan Antibiotik (PGA)
yang merupakan bagian dari Komite
Pengendalian Resistensi Antimikroba
(KPRA) Rumah Sakit.
In the management of infection cases, the decision to give antibiotics
must comply with the following principles.
1. Correct Diagnosis
a. Establish a diagnosis of bacterial infection through
clinical, laboratory and other supporting examinations.
b. To establish definitive therapy, microbiological
examination is required.
2. Right Patient
c. Consider risk factors, other underlying diseases, and co-
morbidities
d. Consider special groups such as pregnant women,
nursing mothers, the elderly, children, infants, neonates.
e. Assess the degree of severity of organ function, for
example in acute kidney disease.
f. Trace a history of allergies, especially antibiotics.
3. Right Type of Antibiotic Consider choosing the type of antibiotic
based on:
g. the ability of antibiotics to reach the site of infection;
h. antibiotic safety;
i. resistance risk impact;
j. results of microbiological examination;
k. guidelines for using antibiotics;
l. listed in the formulary;
m. cost-effective study.
4. Proper Dosing Regimen
Dosage regimen includes dose, route of administration,
interval, and duration of administration. Dosage is a
parameter that always gets attention in antibiotic therapy
because the effectiveness of antimicrobials depends on the
pattern of pathogen susceptibility, minimal inhibitory
concentration (MIC), and pharmacokinetics (PK) and
pharmacodynamics (PD).
a. Nature Dosage
Drug pharmacology is one of the important parameters that
can affect the success of antibiotic therapy. The dosage of
antibiotics is determined by considering:
1) site of infection; the penetration ability of antibiotics
varies in various tissues;
2) degree of severity of infection; in hyperdynamic phase of
sepsis, the volume of distribution and elimination
increases so that the levels of hydrophilic antibiotics are
relatively lower in serum;
3) impaired function of the organs of elimination (kidneys
and liver);
4) weight; Determination of the dose of antibiotics is
generally calculated according to body weight. For obese
patients more than 120% IBW (ideal body weight) a larger
dose of drug is required.
b. Administration route 5. Be aware of side effects and drug interactions
Oral administration as much as possible to be the first Side effects can include allergic reactions and impaired
choice. However, moderate to severe infections may be organ function, for example, impaired kidney function
considered using the parenteral route. Intravenous and hearing loss due to aminoglycosides. Also note the
administration was carried out in the form of a drip for interaction of antibiotics with other drugs. For example,
15 minutes with the concentration and duration of interaction of ceftriaxone with calcium ions will cause
administration according to the rules for using each deposition in blood vessels, interaction of
antibiotic. If the patient's condition improves (for aminoglycosides with MgSO4 causes potentiation of
example: can eat, no gastrointestinal disturbances) neuromuscular block.
then consider stopping antibiotics or changing to the
oral route.
c. Delivery time
The duration of antibiotic administration is determined
by its ability to overcome the infection according to a
confirmed diagnosis. The duration of this therapy can
be extended in patients with certain conditions, such as
SLE or sepsis. Monitoring of clinical and laboratory
improvement is evaluated at least every 3 days based
on clinical, laboratory and other investigation data. If
there is no clinical improvement, then the accuracy of
diagnosis and therapy needs to be re-evaluated.
Reference
• 2021 AWaRe classification: WHO access, watch, reserve,
classification of antibiotics for evaluation and monitoring of use,
WHO, 2021.
• Panduan Penatagunaan Antimikroba di Rumah Sakit, Edisi I, Kemkes
RI, 2021