Pengaruh Konversi Antibiotik Intravena ke Rute Per-oral terhadap Outcome Ekonomi, Klinis dan Humanis pada Pasien Rawat Inap
Abstract
Konversi terapi intravena ke rute per-oral dengan memperhatikan perbaikan hemodinamik pasien dalam 48 jam dapat menghemat biaya pengobatan tanpa mengabaikan efektivitas terapi. Penelitian ini bertujuan untuk mengetahui pengaruh intervensi konversi antibiotik intravena ke rute per-oral terhadap outcome klinis berupa lama rawat inap dan konversi angka leukosit pasien; outcome humanis berupa kualitas hidup pasien (WHOQOL-BREF), dan outcome ekonomi berupa biaya antibiotik pasien. Penelitian ini menggunakan desain kuasi-eksperimental dengan kelompok intervensi dan kontrol, single blind, tanpa randomisasi. Subjek penelitian adalah pasien yang mendapatkan antibiotik seftriakson intravena yang dirawat inap di bangsal penyakit dalam RSUD Prof. Dr. Margono Soekarjo, Purwokerto selama bulan September sampai Oktober 2017. Pasien intervensi mendapatkan intervensi berupa konversi antibiotik lebih awal, yaitu 2 hari setelah diberikan antibiotik intravena. Dilakukan perbandingan lama rawat inap, penurunan angka leukosit, biaya antibiotik, dan kualitas hidup pasien antara kelompok kontrol dan intervensi menggunakan analisis statistik Mann-Whitney dan Independent t-test. Hasil penelitian ini menunjukkan bahwa dari 22 subjek yang terbagi dalam 6 pasien intervensi dan 16 pasien kontrol, terjadi penurunan rata-rata lama rawat inap pasien intervensi dibanding kontrol 3,167:5 hari. Rata-rata biaya antibiotik pada kelompok intervensi lebih rendah dibanding kelompok kontrol yaitu Rp73.886,8 dan Rp173.091,125. Rata-rata selisih angka leukosit akhir pada pasien intervensi yaitu 218,33/mm3, sedangkan pada pasien kontrol 2.076.875/mm3. Kualitas hidup yang dicapai pasien lebih tinggi pada pasien kontrol (+6,6875) dibandingkan pasien intervensi (–1,33) walaupun perbedaan tersebut tidak berbeda signifikan (>0,05). Konversi lebih awal seftriakson intravena menjadi sefiksim oral mampu menurunkan lama rawat inap dan menurunkan biaya antibiotik yang dikeluarkan secara signifikan (0,017 dan 0,003).
Kata kunci: Konversi antibiotik intravena ke oral, outcome ekonomi klinis dan humanis (ECHO),
sefiksim, seftriakson
Impact of Intravenous to Oral Antibiotic Switch Therapy towards Economic, Clinical and Humanistic Outcome in Inpatients
Abstract
Antibiotic conversion from intravenous form to oral form (IV to oral switch) after 48 hours therapy in hemodynamically stable patients can save the cost of treatment without neglecting the effectiveness of therapy. This study aimed to determine the influence of early switch antibiotic from iv to oral on economic clinical humanistic outcome (length of stay in hospital and white blood cell conversion as clinical outcome; quality of life as humanistic outcome using WHOQOL-BREF, and antibiotic cost as economic outcome). This was a quasi-experimental research with control and intervention group, without blinding and randomization. Subjects were inpatients who received ceftriaxone at internal medicine wards of Prof. Dr. Margono Soekarjo hospital for 2 months period from September until October 2017. Intervention group received early antibiotic conversion after 2 days. Length of stay, white blood cell count, quality of life and antibiotic cost were compared between control and intervention groups using Mann-Whitney and Independent t-test. The result showed that from the total of 22 subjects who were divided into intervention group (6 subjects) and control group (16 subjects), there was a decrease in average length of stay of intervention group compared to control (3.167 days and 5 days, respectively). The average of antibiotic cost in intervention group was lower than control group (IDR 73,886.8 and IDR 173,091.125, respectively). The average of white blood cell count in intervention group was 218.33/mm3 while in control group was 2,076,875/mm3. Quality of life of control group was higher (+6,6875) compared to intervention group (–1,33) but was not statistically significant. Early antibiotic switch from ceftriaxone to cefixime could reduce the length of stay and antibiotic cost significantly (0.017 and 0.003).
Keywords: Cefixime, ceftriaxone, economic clinical humanistic outcome, intravenous to oral switch
therapy antibiotic
Keywords
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DOI: https://doi.org/10.15416/ijcp.2019.8.2.81
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