Media Farmasi Indonesia Vol 20 No 1 | DOI 10.
53359/mfi.
EVALUATION OF THE USE OF PROPHYLAXIC ANTIBIOTIC
DRUGS IN HERNIA SURGERY PATIENTS IN MADIUN CITY
HOSPITAL
Afif Mastur Muazzam1.
Yanuar AsAohari Cahyaningrum2.
Zainal Abidin3 Undergraduate Pharmacy Study Program.
STIKES Bhakti Husada Mulia Pharmacy study program.
STIKES Bhakti Husada Mulia Public Health Study Program.
STIKES Bhakti Husada Mulia yanuarashcahya@gmail.
Abstract Hernia ranks 14th as the disease accounting for the most outpatients and inpatients, according to the Ministry of Health.
In 2021, hernia is a disease affecting a total of 20,400 patients.
2018, the ten most common inpatient diseases include hernias, ranking 8th with a total of 286 patients, a percentage of 2.
45% of the total number of inpatients.
Therefore, it is necessary to evaluate treatment for hernias, especially in the selection and administration of drugs during surgery, such as the use of prophylactic antibiotics.
This study aims to evaluate the use of prophylactic antibiotics in hernia surgery patients at Madiun City Regional Hospital.
The research with approach cross-sectional, and data collection has been carried out retrospectively.
The data taken has included patient medical record data with the criteria of patients diagnosed with a hernia, patients who have received surgical operations, patients over 18 years of age or adult patients, and patients with complete medical record data including treatment data and general patient data.
The total results obtained in the study came from the total number of patients affected by hernias, 93% of which were dominated by male patients rather than women, who accounted for only 7%.
The results obtained are of care for hernia surgery and which has the highest d (Defined Daily Dos.
value and is the most frequently used antibiotic is Cefazolin, with a total of 17.
05 d/100 hospital days, is the antibiotic most frequently given, with 72 out of 100 inpatients using cefazolin.
Keywords: ATC/d.
Hernia.
Antibiotic.
Madiun.
INTRODUCTION
According to the Ministry of Health, hernia is the 14th most common disease suffered by outpatients and inpatients, and in 2021, hernia is a disease that attacks a total of 20,400 patients and is one of the causes of the increase in the number of patient admissions to public hospitals in Indonesia.
The prevalence of age-related hernias is common, most often affecting men between the ages of 40 and 80 years.
Hernias most often occur in men, with 95% of cases occurring in the area where the bulge occurs, namely the groin area (Nicholas 2.
The prevalence of hernias in the city of Madiun can be seen in patient data from one of the hospitals in the city of Madiun, namely at Dr.
Soedono Madiun City Hospital, where the 10 diseases most Media Farmasi Indonesia Vol 20 No 1 | DOI 10.
53359/mfi.
frequently treated in hospitals in 2019 were hernias which was ranked 8th with a total of 286 patients or contributing 2.
45% of the total number of inpatientsp (Hospital dr.
Soedono 2.
Surgical procedures are often performed in the treatment of hernias, including gastrointestinal surgery which is one of the main abdominal operations, but almost all gastrointestinal operations fall into the "contaminated" .
lean and dirt.
Gastrointestinal surgery has various characteristics, such as herniotomy, cholecystectomy, colectomy, appendectomy and exploratory laparotomy.
Abdominal surgery, including invasive procedures on the digestive system, especially the stomach, is a risk factor for infection in surgical wounds.
During surgical procedures, open wounds can occur at the surgical site, which can cause infection in the patient (Sjahranie et al.
, therefore prophylactic antibiotic therapy is necessary to prevent infection.
The choice of antibiotic is influenced by the type of surgery to be performed, for prophylaxis most class antibiotics are chosen chephalosporin which is the first generation, is the antibiotic most often used for surgery in patients with no history of allergies (Lukito 2.
According to the 2021 Republic of Indonesia Minister of Health, antibiotics are a category of drugs that have the function of killing microorganisms and treating infections caused by Prophylactic antibiotics are given before, during and after surgical procedures which are useful in reducing the risk of infection and infectious complications resulting from surgical Cephalosporin antibiotics are antibiotics that are often prescribed for surgery or A broad antimicrobial spectrum, a favorable pharmacokinetic profile, a low incidence of side effects, while wise and rational use of antibiotics can be taken into consideration against the spread of resistant bacteria (Republic of Indonesia Minister of Health Evaluation of antibiotic use is used as a basis for determining the quantity of antibiotic use, knowing and evaluating the quality of antibiotic use, establishing systematic and standardized monitoring of antibiotic use, and is carried out with the aim of being an indicator of the use and quality of hospital services.
To assess antibiotic use quantitatively, the World Health Organization (WHO) established the ATC/d system as an international measurement standard (Sjahranie et al.
Based on this explanation, the use and administration of antibiotics requires caution and serious research to find solutions to reduce risks and minimize inaccurate antibiotic therapy, especially when administering antibiotics to hernia surgery patients at the General Hospital in the Madiun City area.
Media Farmasi Indonesia Vol 20 No 1 | DOI 10.
53359/mfi.
METHOD
Research Plan This research design uses a quantitative descriptive method by collecting medical record data from patients diagnosed with hernia who were treated in hospital and treated surgically.
The research design is cross-sectional and data collection is retrospective.
Data were obtained from pharmacy facility medical records and antibiotic treatment therapy files.
Research subject The subjects used in this study were patients who met the inclusion criteria.
Inclusion criteria included patients undergoing antibiotic treatment and hernia surgery, patients aged 18 years or older, and patients with complete medical records.
Data analysis The data obtained will be analyzed by examining antibiotic consumption in Madiun City Hospital inpatient facilities from 2022 to 2024.
Data collected includes medical record number, patient name, gender, patient age, length of stay, name of drug, and drug dosage.
The data was then calculated using the ATC/d method and entered into a table using Microsoft Excel
RESULTS AND DISCUSSION
This research was conducted at the Madiun City Regional Hospital from 2022 to 2024.
Based on the research results, there were 100 patients who met the inclusion criteria.
Table 1.
Patient characteristics by age
Patient Age
Number Of Patient
(%)
18 Ae 25 year 36 Ae 45 year 46 Ae 55 year 56 Ae 65 year 65 year above Total The results obtained by researchers based on age showed that the highest number of patients aged 65 years and over was 58% .
, while those aged 56 to 65 years were 51% .
Therefore, it can be said that hernias tend to occur in elderly patients.
Regardless of age, most hernias originate from the embryo and metastasize from the testicles.
This is due to the protrusion of the abdominal organs into the vaginal opening.
Therefore, direct Media Farmasi Indonesia Vol 20 No 1 | DOI 10.
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inguinal hernia, also called congenital hernia, is the most common type of hernia.
Furthermore, another cause of inguinal hernia is indirect inguinal hernia.
It can be said that any condition that can cause an increase in intra-abdominal pressure can be the cause of an inguinal hernia (Putri et al.
Table 2.
Patient characteristics by gender Gender Gender Number Hernia Patient Precentage (%) Male Female Total Based on the gender of the patient, the majority of patients are male, namely 93% .
, this is in accordance with research presented by (Reza Ika Meliani 2.
which explains that 90% of hernia patients are male.
Men have a higher risk of developing hernias than women, this is caused by bad living habits such as smoking, drinking alcoholic drinks and doing heavy work.
Hernias are also caused by men who do activities that require greater muscle function, such as farming or other heavy work.
Regarding the risk factors for inguinal hernias, it was found that more men suffer from inguinal hernias than women because men do heavier work than women.
This is in accordance with research results (Nugraha et al.
hich show that 98% of subjects are dominated by men.
This is due to anatomical differences between men and women.
Where the diameter of the inguinal canal is larger in women (Wirajaya, et al .
Table 3.
Description of antibiotic use in patients Regimen
Antibiotics Dose Flat flat
Code
ATC
Total Route Usage
Route Precentage Cefazolin
1 x 2 gram
J01DB04
72 Patient IV .
Ampicilin
3 x 1 gram
J01CA01
10 Patient IV .
J01DD08 4 Patient PO .
J01DD04 13 Patient IV .
J01MA02 1 Patient PO .
Cefixime Ceftriaxone Ciprofloxacin 2 x 1 gram The results for the type of antibiotic cefazolin with total drug use were 72% .
In antibiotics, ampicillin was 10% .
, cefixime 4% .
, ceftriaxone 13% .
and ciprofloxacin only 1% .
Each antibiotic is most often given in Media Farmasi Indonesia Vol 20 No 1 | DOI 10.
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injection form, only cefixime and ciprofloxacin are given by the oral route.
The table above shows that out of 100 inpatients at Madiun City Regional Hospital, the antibiotics used with a total of 72 .
%) were cefazolin as the most widely used antibiotic out of the total of all antibiotics used by patients at Madiun City Regional Hospital.
Based on Guideline ASHP (American Society of Health-System Pharmacist.
regarding the management of prophylactic therapy, the recommended choice of therapy for prophylactic antibiotics for hernia surgery is to using first-line cephalosporin antibiotics, namely cefazolin which is given intravenously.
is also explained that the use and administration of therapy is adjusted to body weight and risk factors for infection.
The type of antibiotic used in hernia surgery patients is a single antibiotic.
The cause lies in the bacteria that pose a risk of infection in this case, namely the normal flora of the skin, or gram-positive bacteria.
Additionally, the risk of infection was lower, ranging 0 to 5.
4%, for the type of surgery performed in surgery-only patients.
Therefore, the use of a single dose of the antibiotic cefazolin is considered appropriate as this is in accordance with ASHP guidelines (American Society of Health System Pharmacist.
which in the ASHP guidelines recommends one dose of a first generation cephalosporin which in its application is the antibiotic cefazolin given within 60 minutes before the hernia repair is carried out.
Table 4.
Results of Quantitative Evaluation of Antibiotics for Inpatients with Hernia
Code ATC
Antibiotics Total
d yayayayaoyau yaEyaEyaE
y yayaya
yeOyeayecyeCyeiyeOyeIyeayei J01DB04
17,05
45,9%
J01CA01
10,84
29,2%
J01DD08
2,64
1,78
4,8%
J01DD04
12,94
6,25
16,8%
J01MA02
1,25
3,4%
37,17
TOTAL
Calculations to find the d value (Defined Daily Dos.
calculated by dividing the total dose by the WHO d value, where the total dose is taken from the length of stay and the antibiotic dosing regimen taken by the total daily dose, so that the d value for antibiotics can be found and then all the d based on each antibiotic can be added up.
Cefazolin results were obtained with a total value of 17.
05 d/100 days of treatment, and ampicillin 10.
Media Farmasi Indonesia Vol 20 No 1 | DOI 10.
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d/100 days of treatment, cefixime 1.
78 d/100 days of treatment, ceftriaxone 6.
d/100 days of treatment, ciprofloxacin 1.
25 d/100 days of care.
The results of research on the use of antibiotics in Madiun City Hospital in 2022 - 2024 are in accordance with the latest Minister of Health regulations in 2021, which published regarding surgical and hernia prophylaxis therapy to use a 2 gram dose of cefazolin given 60 minutes before infusion and surgery (Republic of Indonesia Minister of Health 2.
The results obtained by researchers related to antibiotic prophylaxis using the ATC/d method were that the most frequently given drug was cefazolin which was used by 72 patients out of a total of 100 patients.
The application of cefazolin therapy was appropriate and in accordance with the latest Minister of Health Regulations for 2021.
The results of research for 2 months at the Madiun City Regional Hospital showed that the most prescribed antibiotic in the hernia surgery ward at the Madiun City Regional Hospital in 2022 - 2024 in general was cefazolin with a value of 17.
05 d/100 treatment days and was the most frequently prescribed CONCLUSION Description of the characteristics of patients in the hernia surgical ward at Madiun City Regional Hospital with a total of 100 patients, in 2022 - 2024 there are 93% more males .
than females, namely only 7% .
with the highest age The number of hernias affected by those aged 65 years and over was 58% .
Characteristics of drug use using the ATC/d calculation method were obtained.
The total result of cefazolin was 17.
d/100 treatment days as the antibiotic most frequently given with the average use of the drug per patient being 3 days.
The use of cefazolin injection as a prophylactic antibiotic was most often given to 72 patients at a dose of 2 grams.
The administration of antibiotics was considered appropriate and appropriate based on the recommendations of the 2021 Minister of Health Regulation as the main choice of prophylactic antibiotic therapy.
ACKNOWLEDGMENT
Thank you to the Madiun City Regional General Hospital Agency which has given researchers the opportunity to conduct research on the Evaluation of the Use of Antibiotic Drugs in Hernia Surgery Patients at the Madiun City Regional Hospital.
And thank you also to the Stikes Bhakti Husada Mulia Madiun Agency for assisting researchers in the research submission process.
Media Farmasi Indonesia Vol 20 No 1 | DOI 10.
53359/mfi.
REFERENCE