EVALUASI POLA PENGGUNAAN ANTIBIOTIK PADAPASIEN ANAK PENDERITA DEMAM TIFOID DI INSTALASI

RAWAT INAP RS SLAMET RIYADI SURAKARTATAHUN 2010-2011

SKRIPSI

Oleh :

AMILIA FITRIANGGRAINI

K 100080186

FAKULTAS FARMASI

UNIVERSITAS MUHAMMADIYAH SURAKARTA

SURAKARTA

2012

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EVALUASI POLA PENGGUNAAN ANTIBIOTIK PADAPASIEN ANAK PENDERITA DEMAM TIFOID DI INSTALASI

RAWAT INAP RS SLAMET RIYADI SURAKARTATAHUN 2010-2011

SKRIPSI

Diajukan untuk memenuhi salah satu syarat mencapai DerajatSarjana Farmasi (S. Farm) pada Fakultas Farmasi Universitas

Muhammadiyah Surakarta di Surakarta

Oleh :

AMILIA FITRIANGGRAINI

K100080186

FAKULTAS FARMASI

UNIVERSITAS MUHAMMADIYAH SURAKARTA

SURAKARTA

2012

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iv

v

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DAFTAR ISI

Halaman

HALAMAN JUDUL ...................................................................................................... i

HALAMAN PENGESAHAN ......................................................................................... ii

HALAMAN DEKLARASI.............................................................................................. iii

KATA PENGANTAR ..................................................................................................... iv

DAFTAR ISI ................................................................................................................... v

DAFTAR TABEL............................................................................................................ vii

DAFTAR GAMBAR ..................................................................................................... viii

DAFTAR SINGAKATAN ............................................................................................ x

INTISARI ........................................................................................................................ xi

BAB I. PENDAHULUAN .............................................................................................. 1

1. Latar Belakang Masalah .......................................................................................... 1

2. Perumusan Masalah ................................................................................................. 3

3. Tujuan Penelitian ..................................................................................................... 3

4. Tinjauan Pustaka ..................................................................................................... 3

1. Demam Tifoid ................................................................................................... 3

a. Definisi ....................................................................................................... 3

b. Patofisiologi................................................................................................. 3

c. Manifestasi Klinik ....................................................................................... 4

d. Diagnosis .................................................................................................... 5

e. Pencegahan ................................................................................................. 6

2. Antibiotik .......................................................................................................... 8

a. Kebijakan dasar pemberian antibiotik ......................................................... 8

b. Pemilihan antibiotik untuk demam tifoid .................................................. 10

c. Pengobatan dan perawatan komplikasi...................................................... 11

BAB II. METODE PENELITIAN................................................................................. 12

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1. Jenis dan Rancangan Penelitian ..................................................................... 12

2. Batasan Operasional ...................................................................................... 12

3. Alat dan Bahan .............................................................................................. 13

4. Populasi dan Sampel ...................................................................................... 13

5. Kriteria Inklusi ............................................................................................... 13

6. Pengambilan Sampel ..................................................................................... . 14

7. Jalannya Penelitian ....................................................................................... . 14

8. Tempat Penelitian .......................................................................................... . 14

9. Analisis Data ................................................................................................. . 14

BAB III. HASIL PENELITIAN DAN PEMBAHASAN .............................................. . 16

A. Karakteristik Pasien ......................................................................................... . 16

1. Identitas Pasien ............................................................................................. . 16

2. Lama Perawatan Pasien ................................................................................ . 17

3. Kondisi Keluar Pasien .................................................................................. . 18

4. Pemeriksaan Penunjang ............................................................................... . 18

a. Pemeriksaan Leukosit ............................................................................ . 18

b. Uji Widal ............................................................................................... . 19

c. Tes Fungsi Hati ...................................................................................... . 20

B. Karakteristik Obat............................................................................................. . 20

1. Pengobatan dengan Antibiotik .................................................................. . 21

2. Penggunaan Non Antibiotik ...................................................................... . 22

C. Ketepatan Antibiotik ........................................................................................ . 23

1. Tepat Obat ................................................................................................. . 23

2. Tepat Dosis ................................................................................................ . 24

3. Tepat Pasien .............................................................................................. . 26

4. Kesesuaian obat menurut SPO Pelayanan Medis Anak 2009 dan Depkes RI

2006 ........................................................................................................... . 26

BAB IV. KESIMPULAN DAN SARAN ...................................................................... . 28

A. Kesimpulan ...................................................................................................... . 28

B. Saran ................................................................................................................ . 28

DAFTAR PUSTAKA ................................................................................................... . 29

LAMPIRAN .................................................................................................................. . 31

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DAFTAR TABEL

Halaman

Tabel 1. Antibiotik untuk demam tifoid menur ut Depkes RI 2006 .............................. 10

Tabel 2. Karakteristik identitas pasien .......................................................................... 16

Tabel 3. Lama perawatan pasien ................................................................................... 17

Tabel 4. Kondisi keluar pasien ...................................................................................... 18

Tabel 5. Pemeriksaan uji widal ..................................................................................... 20

Tabel 6. Pemeriksaan tes fungsi hati ............................................................................. 20

Tabel 7. Karakteristik penggunaan antibiotik tunggal .................................................. 21

Tabel 8. Karakteristik penggunaan antibiotik kombinasi............................................... 21

Tabel 9. Karakteristik penggunaan non antibiotik ........................................................ 22

Tabel 10. Ketidaktepatan penggunaan obat .................................................................. 23

Tabel 11. Ketidaktepatan dosis antibiotik tunggal ......................................................... 24

Tabel 12. Ketidaktepatan dosis antibiotik kombinasi ................................................... 25

Tabel 13. Ketidaktepatan pasien ................................................................................... 26

Tabel 14. Kesesuaian penggunaan antibiotik ................................................................ 26

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DAFTAR GAMBAR

Halaman

Gambar 1. Pemeriksaan leukosit ................................................................................... 19

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DAFTAR LAMPIRAN

Halaman

Lampiran 1. Tabel pengambilan data pasien.................................................................. 31

Lampiran 2. Tabel hasil uji laboratorium pasien ........................................................... 39

Lampiran 3. Tabel tepat obat ......................................................................................... 43

Lampiran 4. Tabel tepat dosis ........................................................................................ 45

Lampiran 5. Tabel tepat pasien ...................................................................................... 51

Lampiran 6. Tabel evaluasi kerasionalan pengobatan ................................................... 55

Lampiran 7. Surat ijin survay pendahuluan ................................................................... 57

Lampiran 8. Jawaban suran ijin penelitian..................................................................... 58

Lampiran 9. Surat ijin penelitian.................................................................................... 59

Lampiran 10. Surat keterangan selesai penelitian.......................................................... 56

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DAFTAR SINGAKATAN

BB : Berat badan

D (+) : Besaran berlebih

D (-) : Besaran kurang

F(+) : Frekuensi berlebih

F(-) : Frekuensi berkurang

Mg : Miligram

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INTISARI

Demam tifoid dan penggunaan antibiotik masih merupakan masalahkesehatan masyarakat yang penting di sebagian besar negara berkembang didunia, termasuk Indonesia. Penelitian ini bertujuan mengkaji pola penggunaanantibiotik demam tifoid pada anak di instalasi rawat inap RS Slamet RiyadiSurakarta tahun 2010-2011.

Penelitian ini merupakan jenis penelitian non eksperimental denganrancangan analisis secara diskriptif non analitik dan pengambilan data secararetrospektif. Didapatkan jumlah kasus demam tifoid sebanyak 77 kasus. Hasilpenelitian ini disajikan dalam bentuk karakteristik pasien, gambaran penggunaanantibiotik dan analisis kesuaian antibiotik.

Demam tifoid di instalasi rawat inap RS Slamet Riyadi Surakarta tahun2010-2011 antibiotik yang digunakan adalah cefotaxim sebanyak 50 kasus(58,14%), cefixim 14 kasus (16,28%), ceftriaxon 8 kasus (9,30%), amoxicillin 4kasus (4,64%), ampicillin 1 kasus (1,16%), tiamfenikol dan kloramfenikol 2 kasus(2,33%), kombinasi cefixim + kloramfenikol, cefotaxim + amoxicillin, cefotaxim+ ampicillin, cefotaxim + tiamfenikol, tiamfenikol + amoxicillin masing-masingsebanyak 1 kasus (1,16%). Pada analisis kesesuaian penggunaan antibiotik tepatobat sebanyak 72 kasus (93,50%), tepat pasien sebanyak 69 kasus (89,61%) dantepat dosis sebanyak 49 kasus (53,89%).

Kata kunci: demam tifoid, anak, RS Slamet Riyadi Surakarta, antibiotik