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Vol. 03, No. 10, October 2023
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Study Of Quantitative Use Of Antibiotics In Patients Of
Urinary Tract Infection At Rsu X In East Jakarta 2019
Delina Hasan
1
, Yardi
2
, Rosa Amalia
3
Department of Pharmacy, Universitas Pancasila, Jakarta, Indonesia
1
Department of Pharmacy, UIN Syarif Hidayatullah Jakarta, indonesia
2,3
Email; delina.hasan01@gmail.com
Keywords
ABSTRACT
Study, Quantitative, Antibiotics,
Patients, Urinary Tract Infection
Urinary tract infection is a health problem that can increase
morbidity and even increase the death rate both in Indonesia and in
the world. Urinary tract infection is the second most common
infectious disease after upper respiratory tract infection which in its
treatment must use antibiotic therapy, so the treatment must be
appropriate and rational. The purpose of this study was to
determine the use of antibiotics quantitatively using the ATC/DDD
and 90% DU methods in patients with urinary tract infections at
RSU X in East Jakarta. Methods, This research is a descriptive study
using a crosssectional design. Data collection was carried out
retrospectively through the medical records of urinary tract
infection patients at RSU the inclusion and exclusion criteria. The
results showed that the total DDD/100 patientdays in this study was
96.65% with the highest type of antibiotic, namely levofloxacin,
44.07% DDD/100 patientdays. Drugs included in the DU segment
90% were levofloxacin (45.60%), ceftriaxone (21.54%),
cefoperazone (11.33%), and amoxicillin clavulanate (9.00%).
Keywords: Antibiotics, urinary tract infection, ATC/DDD, 90% DU.
INTRODUCTION
Disease infection is one health problem that causes morbidity and even mortality of millions of
residents in various developed and developing countries, including Indonesia (Novard et al. 2019). The
World Health Organization (WHO) stated that as many as 16 million deaths worldwide in 2016 were
caused by disease infection, for one that is infection urinary.
Infection channel Urinary tract (UTI) is a disease infection that occurs Because bacteria inside
urine are found in very large numbers (Dipiro et al. 2014). Infection channel urinary is the most common
second after infection channel upper respiratory (Piraux et al. 2021). The incidence rate of infection
channel urine in the world is spelled out high Enough; a yield study by the American Urological
Association in 2016 stated that around 150 million people experience infection channel, as many as 1.8
million per year (Badalato dan Kaufmann 2017). According to the Centers for Disease Control and
Prevention (CDC), in 2007, approximately 8.6 million people in America suffered from infected channel
urinary, of which 84% occurred in women (Piraux et al. 2021) According to The Ministry of Health of
the Republic of Indonesia in 2014, quoted by Irawan E, Mulyana (2018) stated that the amount of
infection channel urine in Indonesia is estimated to reach 90100 cases per 100,000 population per year
or around 180,000 cases in every the year, where? in the treatment must using antibiotics (Irawan
2018).
Antibiotics used for therapy infection channel urine, in general, are
trimethoprimsulfamethoxazole, fosfomycin, nitrofurantoin, ciprofloxacin, levofloxacin, and amoxicillin-
Inrernational Journal of Social Service and Research https://ijssr.ridwaninstitute.co.id/
IJSSR Page 2493
clavulanate (Dipiro et al. 2014). Based on the survey introduction, the use of antibiotics at RSU X January
and December 2019 shows that antibiotics used to treat infection channels urinary, including cefixime,
ceftriaxone, meropenem, ciprofloxacin, levofloxacin, cefoperazone, clanks ( amoxicillin + clavulanate ),
cefoperazone + sulbactam, fosfomycin, cefepime, cefotaxime, and ampicillin sulbactam.
According to WHO, Antibiotics are a group of drugs used in the world with many incident
infections caused by bacteria, so their use must be appropriate and rational (Kemenkes 2011a).
Research objectives This is to know the use of antibiotics quantitatively with ATC/DDD and DU methods
in 90% of patients with infection channel urine at RSU X in East Jaka in 2019. To reach the objective, a
necessary study of the uses of antibiotics in UTI patients at RSU X in East Jakarta (Kemenkes 2011b).
The study uses analysis with Anatomical Therapeutic Chemical/Defined Daily Dose (ATC/DDD). This
method is a system classification and measurement of the use of drugs WHO recommends. For accuracy,
the average dose per day used antibiotics in patients, adults, and DU is 90% (Aprilia 2017).
The results of research conducted at one of the regional hospitals in the Yogyakarta area in 2004,
2006, and 2008 regarding the comparison use of antibiotics for infection channels with the ATC/DDD
method shows the total DDD value in 2004 was 105.2 DDD/100 patient days, with DU 90%, i.e.,
amoxicillin (41.81%) and ciprofloxacin (47.5%). In 2006, the total DDD value was 107.3 DDD/100
patients with DU 90%, i.e., amoxicillin (40.34%), ciprofloxacin (44.89%), and ceftriaxone (9.37%) (Nisa
2012).
Research conducted at a General Hospital in India in 2011 with the same method shows a total
DDD value of 2.82 DDD/1000 inhabitants day, with a DU of 90%, namely norfloxacin (24.46%), cefixime
(22.34%), amoxicillin (17.02%), metronidazole (15.95%), and ciprofloxacin (14.18%) (Bhamare et al.
2011). Research results similar to ATC/DDD method at home illness in Jepara in 2012 showed a total
DDD value of 100.61 DDD/100 patients, with a DU of 90%, namely ciprofloxacin (31.74%), amoxicillin
(25.72%), ceftriaxone (13.73%), cefotaxime (12.93%), metronidazole (4.48%), and cefixime (2.92%)
(Nisa 2012).
Research results from others with a method similar to home Krishna disease in Karad in 2015
showed a total DDD value of 39.60 DDD/1000 inhabitantsday, with antibiotics that are 90% DU
ceftriaxone (32.60%), azithromycin (14.34%), ciprofloxacin (10.81%), nitrofurantoin (5.85%),
amoxicillin (5.29%), cefixime (4.25%), amikacin ( 3.76%), levofloxacin (2.98%), amoxicillin +
clavulanate (2.81%), cefepime (2.43%), cefodoxime (2.21%) and norfloxacin (1.87%) (Gidamudi et al.
2015).
Study others at home Sick tertiary institutions in South India in 2015 shows a DDD value of 47.38
DDD/1000 inhabitants day, with antibiotics that are 90% DU i.e., cefoperazone + sulbactam (37.53%),
nitrofurantoin (15.32%), ofloxacin (10.09%), ciprofloxacin (8.08%), amikacin (5.42%), norfloxacin
(4.69%), doxycycline (4.60%), and levofloxacin (3.65%) (Sharma dan Oommen 2018).
Results of other studies at home Sick Azeezia, Kollam and Kerala in India in 2018 showed a total
DDD value of 21.79 DDD/1000 inhabitants day, with antibiotics that are 90% DU, i.e., ceftriaxone
(35.52%), ciprofloxacin (20, 47%), cefotaxime (16.98%), ofloxacin (6.56%), norfloxacin (6.06%), and
amikacin (5.14%) (Naik et al. 2016).
Study others at RSUD Dr. Moewardi in 2018 showed a total DDD value of 11.45 DDD/100 patient
days, with antibiotics that are 90% DU, i.e., ceftriaxone (63.97%), levofloxacin (24.42%), ciprofloxacin
(4.34%), meropenem (3.49%), cefoperazone + sulbactam (2.76%), cefazolin (0.58%), and ceftazidime
(0.44%) (Efa Ramadhany Nur Insani dan Mutmainah 2018).
The description background above shows that an infection channel urinary is a disease infection
caused by bacteria, is dangerous and can cause morbidity and even mortality because of studies of
antibiotics in suffering patients with the infected channel. The study was done with the Use of ATC/DDD
and DU 90 % methods; the goal is To know the quantity and type of antibiotics used patient infection
channel treated bladder and Stayed at RSU X in East Jakarta in 2019.
International Journal of Asian Education,
Delina Hasan
1
, Yardi
2
, Rosa Amalia
3
IJSSR Page 2494
METHODS
Research Design
Study This use design study crosssectional with data collection retrospective that is with do
search document record medical patient infection channel treated bladder Stayed at RSU X in East
Jakarta in January December 2019.
Population Study
Population in study This is all over patient mature start age 18 year suffer infection channel
treated bladder inpatient at RSU X from January December 2019. Sample size in study This A total of
115 UTI patients were eligible criteria inclusion and exclusion , Data collected besides characteristics
patient . Use medication , as well as laboratory data as support ( test urinalysis : leukocytes , leukocyte
esterase, and bacteria ), patient with record medical and patient status load information complete .
Data Analysis
Analysis Univariate
Processed data with use analysis univariate is Characteristics Patients include :
a. Age
b. Gender
c. Disease accompanying
d. Long days take care
Data Analysis using ATC/DDD and DU 90% Methods
Data analysis was carried out with count quantity use antibiotics in patients infection channel
urinary in installation take care RSU X stay with processed ATC/DDD method with combination of
Microsoft Excel 2007 programs .
Formula :
RESULTS
Characteristic Data Patient
Table 1. Distribution Frequency Characteristics Patient Infection Channel Urinary at RSU X
in East Jakarta in 2019
No.
Frequency (n =
115)
(%)
1.
43
72
37.4
62.6
2.
19
8
19
23
30
16
16.5
7
16.5
20
26.1
13.9
DDD/100 patient days =
𝑇ℎ𝑒 𝑛𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝑔𝑟𝑎𝑚𝑠 𝑜𝑓 𝑎𝑛𝑡𝑖𝑏𝑖𝑜𝑡𝑖𝑐𝑠 𝑢𝑠𝑒𝑑 𝑏𝑦 𝑡ℎ𝑒 𝑝𝑎𝑡𝑖𝑒𝑛𝑡
𝑊𝐻𝑂 𝑠𝑡𝑎𝑛𝑑𝑎𝑟𝑑 𝐷𝐷𝐷 𝑣𝑎𝑙𝑢𝑒 𝑓𝑜𝑟 𝑎𝑛𝑡𝑖𝑏𝑖𝑜𝑡𝑖𝑐𝑠 𝑖𝑛 𝑔𝑟𝑎𝑚𝑠
𝑥
100
𝑇𝑜𝑡𝑎𝑙 𝐿𝑂𝑆
Inrernational Journal of Social Service and Research https://ijssr.ridwaninstitute.co.id/
IJSSR Page 2495
3.
112
3
97.4
2.6
4.
21
75
19
18.3
65.2
16.5
Table above show characteristics patient infection channel treated bladder stay at RSU X, type
sex most subjects is female (62.6%), age subject range between 1870 years , most range between 5170
years ( around 60%), subjects who had disease comorbidities (97.4%), and length of day take care of
the most range between 47 days (65.2%).
Description of Disease Types Participant
Table 2. Distribution of Disease Types Participant Patient Infection Channel Urination in the
RSU X Inpatient Installation 2019
No.
Disease
Participant
Frequency
(n= 301)
(%)
1
Hypokalemia
31
10.3
2
Dyspepsia
26
8.7
3
Diabetes mellitus
23
7.6
4
Hypertension
20
6.6
5
Anemia
20
6.6
6
Hematuria
15
5.0
Table 2 shows that type disease the most participants occurs in patients infection channel
urinary in installation take care RSU X stays in 2019 are hypokalemia (10.3%), followed dyspepsia
(8.7%), diabetes mellitus (7.6%), hypertension (6.6%), anemia (6.6%), hematuria (5%)
Thousands Dist Profile Use Therapy Antibiotics
Table 3. Distribution Profile Use Therapy Antibiotics in UTI Patients in the RSU X Inpatient
Installation in 2019
No.
Types of
Therapy
Medicine name
Frequency
(n=115)
(%)
1.
Monotherapy
Fluoroquinolones
Levofloxacin
34
29.6
Cephalosporins
Cefoperazone
Ceftriaxone
Cefoperazone + Sulbactam
Cefixime
Cefepim
Cefotaxime
27
24
6
2
1
1
23.5
20.9
5.2
1.7
0.9
0.9
Penicillin
Amoxicillin + clavulanate
Ampicillin + Sulbactam
10
1
8.7
0.9
Carbapenems
Meropenem
3
2.6
Other Groups
Fosfomycin
2
1.7
International Journal of Asian Education,
Delina Hasan
1
, Yardi
2
, Rosa Amalia
3
IJSSR Page 2496
Total
111
96.6
2.
Combination
Penicillin + Fluoroquinolone
( Amoxicillin + clavulanate ) +
Levofloxacin
2
1.7
Fluoroquinolones + Cephalosporins
Levofloxacin + Ceftriaxone
2
1.7
Total
4
3,4
Table 3 shows that use antibiotics grouped based on type therapy received by the patient , where
as many as 96.6% of patients infection channel urinary get monotherapy and 3.4% of patients get
therapy combination . Most antibiotics prescribed as monotherapy is levofloxacin (29.6%), followed
cefoperazone (23.5%), ceftriaxone (20.9%), and amoxicillin + clavulanate (8.7%). Whereas For therapy
combination prescribed antibiotics is (amoxicillin clavulanate) with levofloxacin (1.7%) and
levofloxacin with ceftriaxone (1.7 %).
Table 4. Number of Patient Hospitalization Days Infection Channel Urination at RSU X in 2019
No.
Month
n(115)
LOS ( days )
Average
day
1
January
5
26
5.20
2
February
6
29
4.83
3
March
2
14
7.00
4
April
7
36
5.14
5
May
8
43
5.38
6
June
4
22
5.50
7
July
11
70
6.36
8
August
14
60
4.29
9
September
29
129
4.45
10
October
13
51
3.92
11
November
12
61
5.08
12
December
4
11
2.75
Total
115
552
59.9
Average
9.58
46
4.99
LOS ( length of stay ) is the length of stay stay counted patients since day First patient enter
House Sick until with patient go out from House sick . LOS obtained from record medical a total of 115
samples research . Table 4 shows that the average patient LOS infection channel urinary with or without
disease included in the installation take care Budhi Asih Hospital's stay in 2018 was 5 days. This thing
means that in 2018 from 115 subjects research , the average is treated stay for 5 days with the total
amount day take care patient is 552 days.
Quantity Use Antibiotics Patient Infection Channel Urinate in RSU X in East Jakarta 2019
Table 5. Distribution Use Antibiotics and Calculation DDD value /100 patientdays at Budhi Asih
Regional Hospital for the 2019 period
Group
Drug
Antibiotics
Form
Preparation
DDD
Standar
d Value
from
WHO (g)
Preparation
Strength (g)
Amount
Usage (g)
DDD/100
patient
days
Fluoroquinolones
Levofloxacin
Tablet
0.5
0.5
2.5
44.07
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IJSSR Page 2497
Injection
0.75
119.25
Cephalosporins
Ceftriaxone
Injection
2
1
230
20.82
Cefoperazone
Injection
4
1
242
10.95
Cefixime
Capsule
0.4
0.2
6.48
2.93
Cefepim
Injection
4
1
6
0.27
Cefoperazone +
Sulbactam
Injection
4
1
40
1.81
Cefotaxime
Injection
4
1
27
1.22
Penicillin + Beta
Inhibitor
Lactamase
Amoxicillin +
Clavulanate
Injection
3
1
144
8.69
Ampicillin +
Sulbactam
Injection
6
1
48
1.45
Carbapenems
Meropenem
Injection
3
1
57
3.44
Other Groups
Fosfomycin
Injection
8
2
44
1.00
Table 5 above show that there are 5 groups antibiotics used as therapy in patients infection
channel urinary. after done analysis with There are 4 major DDD methods the antibiotics used , viz
levofloxacin 44.07 DDD/100 patientdays, followed ceftriaxone 20.82 DDD/100 patientdays,
cefoperazone 10.95 DDD/100 patientdays , and amoxicillin clavulanate 8.69 DDD/100 patientdays.
Table 6. Du Profile 90% Usage Antibiotics in Patients Infection Channel Urination at RSU X East
Jakarta 201 9
No.
ATC code
Antibiotics
DDD/100
Patientdays
Use
(%)
DU
segment
1
J01MA12
Levofloxacin
44.07
45.60
90%
2
J01DD04
Ceftriaxone
20.82
21.54
3
J01DD12
Cefoperazone
10.95
11.33
4
J01CR02
Amoxicillin + clavulanate
8.69
9.00
5
J01DH02
Meropenem
3.44
3.56
10%
6
J01DD08
Cefixime
2.93
3.03
7
J01DD62
Cefoperazone +
Sulbactam
1.81
1.87
8
J01CR01
Ampicillin + Sulbactam
1.45
1.50
9
J01DD01
Cefotaxime
1.22
1.26
10
J01XX01
Fosfomycin
1.00
1.03
11
J01DE01
Cefepim
0.27
0.28
Amount
96.65
100.00
Table 6 shows that incoming medication to in DU segment 90% after cumulated is levofloxacin
(45.60%), followed cetriaxone (21.54%), cefoperazone (11.33%), and amoxicillin + clavulanate
(9.00%). Incoming medication to in the 90% DU segment is most medicines its use at RSU X in 2019 .
Discussion
Gender
The table above shows the characteristics of patients with infection channel-treated bladder
stays at Budhi Regional Hospital, where the type sex subject most research is female (62.6%). Research
results This is to a study previously conducted by Mantu et al. (2015), Insani (2018), and Sharma and
Shweta (2018), which stated that patient infection channels urinary Lots manifold female gender.
Research results are also appropriate with the results of the Centers for Disease Control (CDC) in 2007,
which shows that about 8.6 million people in America suffer infection from the urinary tract, 84% of
which occurs in women. Data from The World Health Organization (WHO) in 2011 also stated that as
many as 50% of women experienced infection channels in their lives (Organization 2005). According to
International Journal of Asian Education,
Delina Hasan
1
, Yardi
2
, Rosa Amalia
3
IJSSR Page 2498
theory, This happens Because there exists a difference in anatomy between men and women. By
anatomically long urethra, Women are shorter compared to men, so bacteria from outside more easily
reach birth where the bladder is located near with anus (Setiati et al. 2016). Meanwhile, infection
channel urinary p seldom happens for men because men have a fluid prostate. Its antibacterial can
hinder growth as well as entry of bacteria into the urinary tract (Wong 2009).
Age
Based on age, it was found that the largest number of research subjects with urinary tract
infections at RSU. Based on research conducted, the study results show that the incidence of urinary
tract infections has increased at the age of 40 years. This is in line with previous research conducted at
the Gatot Subroto Army Hospital, Jakarta, regarding antibiotic prescribing patterns in urinary tract
infection patients in 2018, which stated that infections of Urinary tract disease often occur at the age of
40 years and over (Pontoan et al.). This is due to a decrease in body resistance in elderly patients;
besides that, in elderly patients, there are changes in the urinary system, which can reduce the ability to
empty the bladder so that urine in the bladder can cause infection (Hashary et al. 2018). Meanwhile,
urinary tract infections that occur at a young age are generally caused by a lack of maintaining the
cleanliness of intimate organs, sexual activity, and using contraception or spermicidal gel. Sexual activity
can cause bacteria to enter a woman's bladder. At the same time, the use of spermicide can increase
vaginal colonization with Escherichia coli bacteria to vaginal epithelial cells (Lee 2018).
In general, the risk factors for urinary tract infections can increase in postmenopausal women
(women who have been through menopause for one year) because, in postmenopausal women, there is
a decrease in the production of the hormone estrogen, which causes the pH of vaginal fluids to increase,
thereby increasing the development of microorganisms in the vagina. Meanwhile, in men, the increasing
incidence of urinary tract infections is caused by anatomical abnormalities such as prostatic
hypertrophy, fecal incontinence, and catheterization (Wong 2009).
Concomitant Diseases
The results of the study showed that more urinary tract infection patients hospitalized at RSU X
had comorbidities compared to patients without comorbidities. One of the factors that influences the
various types of comorbidities in patients with urinary tract infections is the age of the patients, most of
whom are elderly (Setiati et al. 2016).
The results of this study are in accordance with previous research conducted at Undata Hospital,
Palu regarding the rationality of using antibiotics in patients with urinary tract infections at the
inpatient installation of Undata Hospital, Palu in 2012, which stated that there were more patients with
urinary tract infections accompanied by comorbidities than without comorbidities (Febrianto et al.
2013).
Based on the data obtained, it shows that the type of comorbidity most often experienced by
urinary tract infection patients at RSU The results of this research are in accordance with research
conducted at RSUP DR. Wahidin Sudirohusodo regarding the analysis of the effectiveness and side
effects of antibiotics in urinary tract infection patients in 2018, stated that the comorbidities that often
occur in urinary tract infection patients are diabetes mellitus, hypertension and chronic kidney disease.
This is because diabetes can increase blood sugar and blood sugar levels in the urine, making it easier
for bacteria to reproduce. Apart from diabetes mellitus, hypertension is also a comorbidity which is a
risk factor for urinary tract infections, this is because hypertension is one of the causes of chronic kidney
disease, where one of the complications of chronic kidney disease is immunological disorders which
often cause infections, one of which is infection. urinary tract (Hashary et al. 2018).
Inrernational Journal of Social Service and Research https://ijssr.ridwaninstitute.co.id/
IJSSR Page 2499
However, in this study the most common comorbidity in patients with urinary tract infections
was hypokalemia. According to research conducted by Nathania (2019) hypokalemia can be caused by
several conditions such as diabetes, kidney disease, chronic diarrhea, alcohol withdrawal,
hyperthyroidism, acute myocardial infarction, severe head injury, and use of certain drugs26, which in
this study contained several comorbidities that are at risk of causing hypokalemia in patients with
urinary tract infections, namely diabetes mellitus, chronic kidney disease, acute kidney disease, diabetic
ketoacidosis, kidney stones, renal colic, bilateral nephrotoxicity, kidney cysts, renal abscesses,
contracted kidneys, and nephritis with a total of 20.1%.
Length of treatment days
Based on the length of daycare stay, the results show that the percentage of patient infection
channels undergoing urine take care to stay at RSU X most Lots around 47 days. Research results This
is almost The same as research conducted at Undata Hospital Palu in 2012 on patients with channel
urinary tract infection (UTI). Results show the length of the day taken care of the most from 3 days (Lee
2018). According to theory, in the general condition, patient infection channel urinary without disease
accompanying will improve after three days of antibiotics. Long days take care more stay from 3 days
caused Because part big patient accompanied with other possible diseases worsen condition infection,
so prolongs the healing process (Setiati et al. 2016).
Distribution Profile Use Therapy Antibiotics
Distribution profile uses therapy antibiotics aim For know what antibiotics just used by patients
infection channel urinary in installation take care RSU X 2019 stay. Results in the study show that
patients Often get therapy single compared to therapy combination, where the antibiotic most used as
monotherapy is levofloxacin. Whereas For therapy combination, antibiotics are used amoxicillin
clavulanate plus levofloxacin and levofloxacin plus ceftriaxone. The same with research conducted at
home by Sick Roemani Semarang in 2015 awarded monotherapy antibiotics in patients with infected
channels more Lots used compared to combination therapy (Pratiwi 2017).
According to guidelines for managing infection channel male urinary tract and genitalia,
monotherapy is generally given to patients with infection channel urine that doesn't experience
abnormality anatomical structure 3. At the same time, therapy combination is usually used To reach
effective Work medicine because the right combination will benefit more clinics. Apart from that,
therapy combinations are also possible to give effect synergistic and inhibitory emergence resistance
bacteria to antibiotics used (Gilbert 2006).
In electing antibiotics as therapy in patients' infection channel, generally, there are several
things to consider to reach optimal therapy, including sensitivity to antibiotics, risks, and risk resistance
bacteria to antibiotics. Therefore, for each matter, can be done election treatment with monotherapy or
combination therapy (Dipiro et al. 2014).
Evaluation Use Antibiotics By Quantity In DDD Units
In research This form preparation antibiotics with There are both oral and parenteral routes
mark The same Defined Daily Dose. During 2019 , there were 11 types antibiotics from 5 groups
antibiotics used in patients infection channel urinary , that is antibiotics group penicillins ,
cephalosporins, fluoroquinolones , carbapenems , and groups other. During the year 2019 from January
to December , the total number of days is obtained take care Length of Stay of 115 patients is 552 days
as shown in table 4. The total LOS used in the study This that is For DDD calculation as divider with mark
DDD standard from WHO.
Quantity use antibiotics at RSU X, East Jakarta units DDD/100 patientdays shown in table 4.
Quantity use antibiotics that have amount the highest in 2019 was levofloxacin . DDD calculation for
levofloxacin in 2019 reached 44.07 DDD/100 patient days . This thing show that there were 44 patients
from all over subject research that consumed 1 DDD levofloxacin as big as 0.5 grams every the day .
International Journal of Asian Education,
Delina Hasan
1
, Yardi
2
, Rosa Amalia
3
IJSSR Page 2500
Levofloxacin is antibiotics spectrum wide group fluoroquinolones generation third with more
activity Good to gram positive bacteria and have level resistance bacteria to more antibiotics low
compared to group fluoroquinolones others , p This because Lots study show that as many as 2030%
Bacteria reason infection channel urinary resistant to antibiotics group fluoroquinolones, especially
ciprofloxacin (Sofyan et al. 2014; Adil dan Kundarto 2019).
Levofloxacin is a recommended antibiotic as therapy empiric in patients with infected channels
because levofloxacin can reach expected levels both in serum and urine. Levofloxacin is also included in
the formulary list as therapy For infection tract (Gilbert 2006; Fiotista 2020).
Mechanism Work levofloxacin as an antibiotic that hinders the formation of bacterial DNA with
a method that inhibits topoisomerase II (functional DNA gyrase ). To maintain superhelical bacteria,
DNA is required For DNA replication and transcription, DNA repair, recombination, and transition ), and
bacterial topoisomerase IV, to prevent relaxation, requires a DNA chain For transcription and
replication.
Levofloxacin is at its peak. It works for 12 hours, is excreted through the kidneys, and has a
relative half-life, i.e., 68 hours, so it can given with a dose once a day at (Hardman dan Limbird 1980;
Lacy et al. 2009). Levofloxacin is an antibiotics spectrum wide group fluoroquinolones generation third
with more activity Good to gram-positive bacteria. It has low resistance bacteria to more antibiotics
compared to group fluoroquinolones and others. The results of other studies show that about 2030% of
bacteria cause infection channel urinary resistance against class antibiotics fluoroquinolones, especially
ciprofloxacin (Sofyan et al. 2014; Adil dan Kundarto 2019).
Profile Use Antibiotics Based on DU 90%
Drug Utilization (DU) of 90% was obtained with method share number of DDD/100 patientdays,
based on type antibiotics used at RSU X in East Jakarta with a total of DDD/100 patientdays from all
over antibiotics used then times 100%. Percentage use antibiotics furthermore cumulated and sorted
from percentage highest to percentage lowest . Incoming medication the 90% DU segment is incoming
medication in 90% accumulation on usage . DU profile 90% usage antibiotics based on type antibiotics
at RSU X 2019 can seen in table 6.
Table 6 shows that incoming antibiotics in segment 90% usage (DU 90%) consists from
levofloxacin (45.60%), ceftriaxone (21.54%), cefoperazone (11.33%), amoxicillin clavulanate (9.00%).
Whereas incoming antibiotics in DU segment 10% are meropenem (3.56%), cefixime (3.03%),
cefoperazone sulbactam (1.87%), ampicillin sulbactam (1.50%), cefotaxime (1.26%), fosfomycin
(1.03%), and cefepime (0.28%). Research results This different with research conducted at home sick
Dr. Moewardi showed it that antibiotics with DU 90% at home Sick the is ceftriaxone (63.97%),
levofloxacin (24.42%), ciprofloxacin (4.34%), meropenem (3.49%), cefoperazone + sulbactam (2.76%),
CONCLUSION
Antibiotics used on patients infection channel urinary in installation take care There were 11
types of inpatient stays at RSU X in East Jakarta in 2019 antibiotics In form single ( Levofloxacin ,
Ceftriaxone , Cefoperazone , Meropenem, Cefixime , Cefotaxime , Fosfomycin , Cefepime , whereas , in
form combination Amoxicillin clavulanate , Cefoperazone sulbactam , and ampicillin sulbactam ,
Analysis results quantitative The total DDD/100 patientdays obtained is 96.65% with each DDD/100
patientdays value levofloxacin 44.07 %, ceftriaxone 20.82 %, cefoperazone 10.95% , amoxicillin
clavulanate 8.69 %, meropenem 3.44 % cefixime 2.93 % cefoperazone sulbactam 1.81%, ampicillin
sulbactam 1.45% cefotaxime 1.22% fosfomycin 1.00% , and cefepime 0.27%. Incoming antibiotics in
Inrernational Journal of Social Service and Research https://ijssr.ridwaninstitute.co.id/
IJSSR Page 2501
the 90% DU segment is levofloxacin 45.60%, ceftriaxone 21.54%, cefoperazone 11.33%, and amoxicillin
clavulanate 9.00%.
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