Penambahan Ciprofloksacin Intravena terhadap Ceftriakson sebagai Terapi Antibiotik Empiris pada Pasien Pneumonia Rawat Inap: Perbandingan Biaya dan Efektivitas

Afifah Machlaurin, Satibi Satibi, Nanang Munif Yasin

Abstract


Abstract
In clinical practices the aim of adding antibiotics treatment was to improve the outcomes. The objective
of this study was to assess whether adding intravenous ciprofloxacin could bear more benefit despite
the cost of treatment than that of intravenous ceftriaxone for hospitalized pneumonia. This retrospective
study devided patients with pneumonia into two groups; first, patients received intravenous ceftriaxone
therapy only (CTX group), second, patients received combination of intravenous ceftriaxone plus
ciprofloxacin (CTXCP group). There were 171 patients recruited, 106 patients received CTX treatment
and 65 patients received CTXCP. The data were matched between groups by age, gender, level of payment
and comorbidities. The total cost of treating hospitalized pneumonia with CTXCP was higher than CTX
(p=0,000). Meanwhile, the length of stay (LOS) and length of stay antbiotic related (LOSAR) were shorter
in CTX group than CTXCP (11,32 vs 13,15 days, p=0,14 and 9,26 vs 12,09 days, p=0,000). Moreover, the
success rate and first line clinal failure avoided (CFA) in CTX group were better than CTXCP (81,13% vs
66,15%, p=0,027 and 71,79% vs 44,62%, p=0,000). This research concluded that adding ciprofloxacin
intravenous as empiric treatment of hospitalized pneumonia did not improve outcomes but significantly
increased the cost of treatment.
Keywords: pneumonia, ceftriaxone, ciprofloxacin, cost, effectiveness

 

Abstrak
Salah satu tujuan penambahan terapi antibiotik dalam praktek klinis adalah untuk meningkatkan hasil
terapi. Namun hal tersebut dapat meningkatkan biaya perawatan. Tujuan dari penelitian ini adalah
untuk mengetahui apakah penambahan terapi antibiotik ciprofloksacin akan meningkatkan efektifitas
meskipun menambah biaya dibandingkan dengan monoterapi ceftriakson pada pasien pneumonia rawat
inap. Penelitian ini mengambil data pasien pneumonia secara retrospektif dan membaginya menjadi dua
kelompok; pertama, kelompok monoterapi ceftriakson (CTX); kedua, kelompok kombinasi ciprofloksacin
dan ceftriakson (CTXCP). Sejumlah 171 pasien pneumonia yang memenuhi kriteria, 106 pasien masuk
kelompok CTX dan 65 pasien masuk dalam kelompok CTXCP. Kedua kelompok memiliki karakteristik
yang sama dari segi jenis kelamin, usia, jenis pembayaran, dan penyakit komorbiditas. Hasil analisis
menunjukkan total biaya perawatan pada kelompok CTXCP lebih tinggi dari pada kelompok CTX (Rp.
12.120.000 vs Rp. 9.020.000, p=0,000). Perbandingan efektifitas menunjukkan lama rawat inap (length
of stay,LOS) dan lama pemberian antibiotik saat rawat inap (length of stay antibiotic related,LOSAR)
kelompok CTX lebih pendek dibandingkan CTXCP (11,32 vs 13,15 hari, p=0,14 and 9,26 vs 12,09
hari, p=0,000). Selain itu, tingkat keberhasilan terapi dan kegagalan antibiotik pertama (first line clinical
failure avoided,CFA) juga lebih bagus pada kelompok CTX (81,13% vs 66,15%, p=0,027 dan 71,79%
vs 44,62%, p=0,000). Dari penelitian ini dapat disimpulkan bahwa penambahan terapi ciprofloksacin sebagai terapi empiris pada pasien pneumonia rawat inap membutuhkan biaya yang lebih tinggi
namun menghasilkan efektifitas yang lebih rendah dibandingkan monoterapi ceftriakson.
Kata kunci: pneumonia, ceftriakson, ciprofloksacin, biaya, efektivitas


Keywords


pneumonia, ceftriaxone, ciprofloxacin, cost, effectiveness

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