Perbandingan Efektivitas Ampisilin dengan Ampisilin-Gentamisin pada Pasien Balita dengan Pneumonia
Abstract
Pneumonia merupakan salah satu penyebab utama kematian anak usia di bawah lima tahun (balita) di dunia. Terapi antibiotik untuk pneumonia biasanya dipilih secara empirik karena mikroorganisme penyebab pneumonia belum dapat diketahui saat diagnosis. Penelitian ini bertujuan untuk membandingkan efektivitas terapi antibiotik empirik pneumonia dengan menggunakan ampisilin tunggal maupun dikombinasikan dengan gentamisin pada balita yang dirawat dengan pneumonia di salah satu rumah sakit di kota Bandung pada tahun 2013–2015. Metode penelitian yang digunakan adalah potong lintang dengan pengambilan data sekunder secara retrospektif. Data yang diperoleh dianalisis dengan uji Chi Square, uji Fisher, dan uji Mann-Whitney. Hasil penelitian menunjukkan bahwa tidak ada perbedaan efektivitas antara pasien yang diterapi menggunakan ampisilin maupun ampisilin-gentamisin dari parameter perbaikan batuk (p=0,381), sesak (p=0,294), demam (p=0,405), maupun laju pernapasan (p=0,306), namun terdapat perbedaan pada lama hari rawat (p<0,001). Tidak adanya perbedaan efektivitas pada parameter perbaikan gejala (sesak dan batuk) dan tanda (suhu tubuh dan laju pernapasan) tersebut dapat menjadi dasar untuk rekomendasi penggunaan ampisilin tunggal sebagai pilihan terapi utama pada pasien pneumonia balita. Selain pertimbangan efektivitas terapi, pemberian terapi antibiotik harus memperhatikan aspek lain seperti pola kepekaan bakteri, risiko efek samping pada pasien, serta efektivitas biaya.
Kata kunci: Anak, antibiotik, efektivitas, pneumonia, terapi empirik
Effectiveness of Ampicillin and Ampicillin-Gentamicin for Children under Five Years Old with Pneumonia
Pneumonia was one of the main causes of mortality in children aged under five years old. Empirical antibiotic therapy was usually selected in pneumonia because the microorganisms have not been known at diagnosis. The purpose of this study was to compare the effectiveness of empirical antibiotic therapy using ampicillin or ampicillin-gentamicin for children aged under five years old with pneumonia at one hospital in Bandung in period of 2013–2015. The method used in this study was cross-sectional method with retrospective data collection. Collected data were analyzed using Chi-Square, Fisher, and Mann-Whitney methods. The results showed that there was no difference in effectiveness between patients treated with ampicillin and ampicillin-gentamicin from improvement of cough (p=0.381), shortness of breath (p=0.294), fever (p=0.405), and respiratory rate (p=0.306) parameters but there was a difference in length of stay (p<0.001). Therefore, it might be the basis for the use of a single ampicillin as a primary treatment option in pneumonia for children aged under five years old. In addition, antibiotic therapy should consider other aspects such as bacterial susceptibility patterns, the risk of side effects in patients, as well as cost effectiveness.
Keywords: Antibiotic, children, effectiveness, empirical therapy, pneumonia
Keywords
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Ministry of Health of the Republic of Indonesia. Indonesian health profile, 2015. Jakarta: Ministry of Health of the Republic of Indonesia; 2016.
UNICEF. Committing to child survival: A promise renewed – progress report 2015. New York: UNICEF; 2015.
Ministry of Health RI. Pneumonia standard management module. Jakarta: Ministry of Health RI; 2012.
Calzada SR, Tomas RM, Romero MJC, Moragón EM, Cataluña JJS, Villanueva RM. Empiric treatment in hospitalized community-acquired pneumonia. Impact on mortality, length of stay and re-admission. Respir Med. 2007;101(9):1909–15. doi: 10.1016/j.rmed.2007.04.018
Principi N, Susanna E. Management of severe community-acquired pneumonia of children in developing and developed countries. Thorax. 2011;66(9):815–22. doi: 10.1136/thx.2010.142604.
World Health Organization. Revised WHO classification and treatment of childhood pneumonia at health facilities. Switzerland: WHO; 2014.
Lassi ZS, Das JK, Haider SW, Salam RA, Qazi SA, Bhutta ZA. Systematic review on antibiotic therapy for pneumonia in children between 2 and 59 months of age. Arch Dis Child. 2014;99(7):687–93.
Lodha R, Kabra SK, Pandey RM. Antibiotic for community-acquired pneumonia in children. Cochrane Database Syst Rev. 2013;6:CD004874. doi: 10.1002/14651858.CD004874.pub4.
Bradley JS, Byington CL, Shah SS, Alverson B, Carter ER, Harrison C, et al. The management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clin Infect Dis. 2011;53(7):e25–76. doi: 10.1093/cid/cir531.
Aliberti S, Amir A, Peyrani P, Mirsaeidi M, Allen M, Moffett BK, et al. Incidence, etiology, timing, and risk factors for clinical failure in hospitalized patients with community-acquired pneumonia. Chest. 2008;134(5):955–62. doi: 10.1378/chest.08-0334.
Asghar R, Banajeh S, Egas J, Hibberd P, Iqbal I, Katep-Bwalya M, et al. Chloramphenicol versus ampicillin plus gentamicin for community acquired very severe pneumonia among children aged 2–59 months in low resource settings: Multicentre randomised controlled trial (SPEAR study). BMJ. 2008;336(7635): 80–4. doi: 10.1136/bmj.39421.435949.BE.
Dellit TH, Owens RC, McGowan JE, Gerding DN, Weinstein RA, Burke JP, et al. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis. 2007;44(2):159–77. doi: 10.1086/510393
Hidron AI, Edwards JR, Patel J, Horan TC, Sievert DM, Pollock DA, et al. Antimicrobial-resistant pathogens associated with healthcare-associated infection: Annual summary of data reported to the National Healthcare Safety Network at the Centres for Disease Control and Prevention. Infect Control Hosp Epidemiol. 2008;29(11):996–1011. doi: 10.1086/591861.
Lemeshow S, Hosmer DW, Klar J, Lwanga SK. Adequacy of sample size in health studies. West Sussex: John Wiley & Sons Ltd.; 1990.
da Fonseca Lima EJ, Mello MJG, Albuquerque M de FPM de, Lopes MIL, Serra GHC, Lima DEP, et al. Risk factors for community-acquired pneumonia in children under five years of age in the post-pneumococcal conjugate vaccine era in Brazil: A case control study. BMC Pediatrics. 2016;16:157. doi: 10.1186/s12887-016-0695-6
Muenchhoff M, Goulder PJR. Sex differences in pediatric infectious diseases. J Infect Dis. 2014;209(3):S120–6. doi: 10.1093/infdis/jiu232
Karki S, Fitzpatrick AL, Shrestha S. Risk factors for pneumonia in children under 5 years in a teaching hospital in Nepal. Kathmandu Univ Med J (KUMJ). 2014;12(48):247–52.
Nguyen TKP, Tran TH, Roberts CL, Fox GJ, Graham SM, Marais BJ. Risk factors for child pneumonia - focus on the Western Pacific Region. Paediatr Respir Rev. 2017;21:95–101. doi: 10.1016/j.prrv.2016.07.002
Queen MA, Myers AL, Hall M, Shah SS, Williams DJ, Auger KA, et al. Comparative effectiveness of empiric antibiotics for community-acquired pneumonia. Pediatrics. 2014;133(1):e23–9. doi: 10.1542/peds.2013-1773.
Williams DJ, Hall M, Shah SS, Parikh K, Tyler A, Neuman MI, et al. Narrow vs broad-spectrum antimicrobial therapy for children hospitalized with pneumonia. Pediatrics. 2013;132(5):e1141–9. doi: 10.1542/peds.2013-1614
Marcus R, Paul M, Elphick H, Leibovici L. Clinical implications of β-lactam–aminoglycoside synergism: systematic review of randomised trials. Int J Antimicrob Agents 2011;37(6):491–503. doi: 10.1016/j.ijantimicag.2010.11.029
Thomson J, Ambroggio L, Kurowski EM, Statile A, Graham C, Courter JD, et al. Hospital outcomes associated with guideline recommended antibiotic therapy for pediatric pneumonia. J Hosp Med. 2015;10(1):13–18. doi: 10.1002/jhm.2265
Hasali MAA, Ibrahim MIM, Sulaiman SAS, Ahmad Z, Hasali JBA. A clinical and economic study of community-acquired pneumonia between single versus combination therapy. Pharm World Sci. 2005;27(3):249–53. doi: 10.1007/s11096-004-7039-6
DOI: https://doi.org/10.15416/ijcp.2018.7.1.52
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