Form Evaluasi kualitas penggunaan antibiotik

(Vd Meer & Gyssens flowchart)

No Nama antibiotik Rejimen Rute Tipe terapi Indikasi Tgl Tgl Kategori(Gyssens) KET
Kode Dosis (P/E/EE/D) mulai stop VI V IV III A III B II I 0
pasien (A/B/C/D) (A/B/C)

Tn MU Meropenem 3x1 g IV E 01/01 20/01 IIIA

1264xx Cefoperazon 2x1 g IV D 10/01 15/01 0

xx Sulbactam

Micamine 1x100 mg IV D 13/01 19/01 0

Tygecyclin 50mg/12 jam IV D 16/01 19/01 V

Metronidazole 500mg/8jam IV D 19/01 19/01 I

Keterangan Tipe Terapi :

P = Antibiotik Profilaksis
E = Antibiotik Empiris
EE = Antibiotik Extended Empiris
D = Antibiotik Definitif