RSU HAJI SURABAYA

NOVITA ARBIANTI
Peserta pelatihan mampu menjelaskan
antibiotik rasional, dan pengendalian
penggunaan antibiotik, sesuai permenkes no 8
tahun 2015
 Menjelaskan latar belakang penggunaan antibiotik
bijak rasional
 Memahami mekanisme resistensi antimikroba
 Memahami strategi pencegahan dan pengendalian
bakteri resisten
 WHO  laporan surveilans 2014 :
- Sefalosporin generasi 3  gagal untuk terapi
gonoroe
- Resistensi flurokuinolon untuk terapi ISK (E.coli)
- Resistensi lini I betalaktam untuk terapi S.aureus
(MRSA)
- Resistensi terhadap karbapenem (ESBL)
 Plasmid  gen pengkode resistensi
 Selective pressure

Peningkatan mikroba resisten :

1. Transmisi mikroba resisten  kewaspadaan standar
2. Selective pressure  pengendalian penggunaan
antibiotik
Emergence of antimicrobial
resistance - AM resistance
- Increase use
- Over use Inappropriate - Collateral damage
- Misuse use - Increase morbidity/mortality
- Under use - Higher cost

Need AM policy to control AM usage!

Ref. WHO policy perspective on medicines :

containing antimicrobial resistance.
WHO, Geneva, 2005
 Prevent AM/AB resistance in health care
settings

Prevent Wisely use

selection of AM/AB

Prevent General
transmission precaution
standard

* WHO report in infectious disease. WHO/CDS/2000.2

* CDC campaign to prevent AM resistance in health care
settings.
http://www.cdc.gov/drugresistance/healthcare/
ha/12steps_HA.htm
 Class A Class B Class C

Aminoglycoside Cephalosporine Vancomycin

Penicillin gen III Teicoplanin
Cephalosporin Fluoroquinolone Linezolide
gen.I,II gen III-IV Cefepime
Chloramphenicol Ertapenem Cefpirome
Fucidic acid Monobactam Ceftazidime
Lincosamide Pip-Tazo
Macrolide Carbapenem
Nitroimidazol Tigecycline
Fluoroquinolone
gen.I,II
Tetracyline
TMP-SMX
Fosfomycin
Polypeptide
 Classification of antibiotics
Class A : Not restricted
Class B : Not restricted, under supervision
Class C : Restricted (Pre-approval / Pre
autorization)
 Implementation
 Evaluation and surveillance
 Auditing
 Community Hospital
Acquired Acquired

Outpatient Class A Class A

Inpatient
WARD Mild
Class C
Moderate
Severe
Class B

ICU
Class B/C Class C