IMPACT OF ANTIMICROBIAL STEWARDSHIP PROGRAM ON THE USE OF ANTIBIOTICS IN PNEUMONIA PATIENTS AT TEACHING HOSPITAL IN SURAKARTA INDONESIA
Keywords:Antimicrobial stewardship program, Gyssens, Pneumonia, Quantitative, Qualitative
Objective: Antibiotic resistance is a serious problem worldwide. One cause of antibacterial resistance is the inappropriate use of antibiotics. The
study of antibiotic use in hospitals found that 30–80% were not based on indications. Antimicrobial Stewardship Programs (ASP) was developed to
control antimicrobial resistance. This study aims to evaluate the impact of ASP in pneumonia patients qualitatively and quantitatively pre-post ASP
Methods: This research is a non-experimental study. Data were taken from the medical records of pneumonia patients and analyzed qualitatively
using the Gyssens method and quantitatively using the Defined Daily Dose (DDD) method. Sampling was conducted through purposive sampling and
results were described descriptively.
Results: During the study period, 96 samples were obtained with 48 data pre-ASP and 48 data post-ASP. The results of the qualitative analysis using
the Gyssens method show an increase in the prudent use of antibiotics from 31.25% to 62.5% pre-post ASP, respectively. Quantitative evaluation
shows a decrease of antibiotic use pre-post ASP from 90.84 DDD/100 patients-days to 61.42 DDD/100 patients-days.
Conclusion: The ASP can improve the quality of antibiotic use in pneumonia patients quantitatively and qualitatively.
resistance crisis: Causes, consequences, and management. Front Public
2. World Health Organization. Antibiotic Resistance. Geneva: World
Health Organization; 2018. Available from: http://www.who.int/newsroom/
fact-sheets/detail/antibiotic-resistance. [Last accessed on 2018
3. Kemenkes RI. Peraturan Menteri Kesehatan Republik Indonesia
Nomor 2406/MENKES/PER/XII/2011. Jakarta: Kementrian Kesehatan
Republik Indonesia; 2011.
4. Coxeter PD, Mar CD, Hoffmann TC. Parents’ expectations and
experiences of antibiotics for acute respiratory infections in primary
care. Ann Fam Med 2017;152:149-54.
5. MacDougall C, Polk RE, Antimicrobial stewardship programs in health
care systems. Clin Microbiol Rev 2005;184:638-56.
6. Kemenkes. National Action Plan on Antimicrobial Resistance
Indonesia 2017-2019. Jakarta: Kementerian Kesehatan Republik
7. World Health Organization. WHOCC-Use of ATC/DDD. Geneva:
World Health Organization; 2018. Available from: https://www.whocc.
no/use_of_atc_ddd. [Last accessed on 2019 Dec 04].
8. Gyssens IG. Antibiotic policy. Int J Antimicrob Agents
9. Kemenkes. Riset Kesehatan Dasar 2013. Badan Penelitian dan
Pengembangan Kesehatan Indonesia: Departemen Kesehatan Republik
10. Dinkes. Profil Kesehatan Provinsi Jawa Tengah 2018 Cetak;
2018. Available from: http://www.dinkesjatengprov.go.id/v2018/
dokumen/profil_2018/mobile/index.html. [Last accessed on 2019
11. Howie SR, Graham SM. Pneumonia, Internationa Encyclopedia of
Public Helath; 2017. Available from: https://www.sciencedirect.com/
topics/earth-and-planetary-sciences/pneumonia. [Last accessed on
2019 Dec 05].
12. Watkins RR, Lemonovich TL. Diagnosis of community-acquired
pneumonia in adults. Exp Rev Respir Med 2009;32:153-64.
13. World Health Organization. Guidelines for ATC Classification and
DDD Assignment 2018. Geneva: World Health Organization; 2017.
Available: https://www.drugsandalcohol.ie/29364. [Last accessed on
2019 Dec 04].
14. Moremi N, Claus H, Mshana SE. Antimicrobial resistance pattern: A
report of microbiological cultures at a tertiary hospital in Tanzania.
BMC Infect Dis 2016;161:756.
15. Newman RE, Hedican EB, Herigon JC, Williams DD, Williams AR,
Newland JG. Impact of a guideline on management of children
hospitalized with community-acquired pneumonia. Pediatrics
16. Centers for Disease Control and Prevention. Core Elements of Hospital
Antibiotic Stewardship Programs. Atlanta GA: US Department of
Health and Human Services; 2019.
17. Centers for Disease Control and Prevention. Antibiotic Resistance
Threats in the United States. Georgia, United States: U.S. Department
of Health and Human Services Centers for Disease Control and
Prevention; 2013. Available from: https://www.cdc.gov/drugresistance/
18. Singh AP, Gupta DU, Das S. Monitor the use of antibiotics in intensive
care units with special focus on restricted antibiotics in tertiary care
hospital of India. Asian J Pharm Clin Res 2016;1:256-9.
19. Ibrahim OM, Saber-Ayad M. Antibiotics misuse in different hospital
wards (a pilot study in an Egyptian hospital). Asian J Pharm Clin Res