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SKRIPSI
ROHMATUN CHOIRIN AMALIA
STUDI PENGGUNAAN CEFTRIAXONE PADA
PASIEN PNEUMONIA KOMUNITAS DI
INSTALASI RAWAT INAP
(Penelitian dilakukan di Rumah Sakit Umum
Karsa Husada Batu)
PROGRAM STUDI FARMASI
FAKULTAS ILMU KESEHATAN
UNIVERSITAS MUHAMMADIYAH MALANG
2016
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iv
iv
KATA PENGANTAR
Bismillahhirrohmanirrohim
Assalamu’alaikum warohmatullahi wabarokatuh
Puji sykur tercurahkan hanya kepada Allah SWT, karena atas rahmat dan
ridho-NYA, penulis dapat menyelesaikan skripsi yang berjudul STUDI
PENGGUNAAN CEFTRIAXONE PADA PASIEN PNEUMONIA
KOMUNITAS DI INSTALASI RAWAT INAP (Penelitian dilakukan di Rumah
Sakit Umum Karsa Husada Batu).
Skirpsi ini diajukan untuk memenuhi syarat untuk mencapai gelar Sarjana
Farmasi pada Program Studi Farmasi Fakultas Ilmu Kesehatan Universitas
Muhammadiyah Malang. Dalam penyusunan skripsi ini, penulis tidak terlepas dari
peranan pembimbing dan bantuan dari seluruh pihak. Oleh karena itu, dengan segala
kerendahan hati, penulis ingin mengucapkan banyak terima kasih kepada:
1. Allah SWT yang telah memberikan rahmat, nikmat, dan hidayah kepada
umat-NYA, Rosululloh SAW, yang menuntun kita menuju jalan yang benar.
2. Bapak Yoyok Bekti Prasetyo, S.Kep.,M.Kep.,Sp.Kom., selaku dekan Fakultas
Ilmu Kesehatan Universitas Muhammadiyah Malang.
3. Direktur Rumah Sakit dan Ketua Instalasi Farmasi Rumah Sakit Umum
Karsa Husada Batu yang berkenan menerima dan mengizinkan penulis untuk
melakukan penelitian skripsi di bagian rekam medik.
4. Ibu Hidajah Rachmawati, S.Si.,Sp.FRS, selaku Dosen Pembimbing I, yang
dengan tulus dan ikhlas serta penuh kesabaran, membimbing, mengarahkan
dan memberikan kemudahan, sehingga skripsi ini dapat terselesaikan dengan
baik.
5. Bapak Drs. Didik Hasmono, MS.,Apt., selaku Dosen Pembimbing II, yang
meluangkan waktu, disela kesibukan bapak untuk membimbing dan memberi
pengarahan serta dorongan moril sampai terselesaikannya skripsi ini.
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DAFTAR ISI
JUDUL …. ............................................................................................................................ i
LEMBAR PENGESAHAN ................................................................................................... ii
LEMBAR PENGUJIAN ...................................................................................................... iii
DAFTAR ISI ....................................................................................................................... iv
DAFTAR TABEL................................................................................................................ vi
DAFTAR GAMBAR .......................................................................................................... vii
DAFTAR LAMPIRAN ...................................................................................................... viii
BAB I PENDAHULUAN ..................................................................................................... 1
1.1 Latar belakang....................................................................................................... 1
1.2 Rumusan Masalah ................................................................................................. 4
1.3 Tujuan Penelitian .................................................................................................. 4
1.4 Manfaat ................................................................................................................. 5
BAB II TINJAUAN PUSTAKA ........................................................................................... 6
2.1 Pneumonia ............................................................................................................ 6
2.1.1 Definisi Pneumonia ..................................................................................... 6
2.1.2 Epidemiologi Pneumonia ............................................................................. 6
2.1.3 Etiologi Pneumonia ..................................................................................... 7
2.1.4 Patofisiologi Pneumonia .............................................................................. 8
2.1.5 Klasifikasi dan Faktor Resiko Pneumonia .................................................. 10
2.1.6 Komplikasi Pneumonia .............................................................................. 11
2.1.7 Manifestasi Klinis Pneumonia ................................................................... 11
2.1.8 Terapi Pneumonia...................................................................................... 12
2.1.8.1 Terapi Suportif Pneumonia ..................................................................... 12
2.1.8.2 Terapi Antibiotika Pneumonia ................................................................ 13
2.2 Pneumonia Komunitas ........................................................................................ 15
2.2.1 Definisi Pneumonia Komunitas ................................................................. 15
2.2.2 Etiologi Peumonia Komunitas .................................................................... 15
2.2.3 Patofisiologi Pneumonia komunitas ............................................................ 16
2.2.4 Terapi Pneumonia komunitas...................................................................... 16
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2.2.4.1 Pengobatan Suportif Pneumonia Komunitas ........................................... 16
2.2.4.2 Pengobatan Antibiotika Pneumonia Komunitas ...................................... 17
2.3 Pneumonia Nosokomial ...................................................................................... 21
2.3.1 Definisi Pneumonia Nosokomial ............................................................... 21
2.3.2 Etiologi Pneumonia Nosokomial ............................................................... 21
2.3.3 Patofisiologi Pneumonia Nosokomial ........................................................ 22
2.3.4 Terapi Pneumonia Nosokomial .................................................................. 22
2.4 Tinjauan Sefalosporin ......................................................................................... 24
2.5 Tinjauan Ceftriaxone ........................................................................................... 24
2.5.1 Mekanisme Kerja Ceftriaxone .................................................................. 25
2.5.2 Sifat Farmakodinamik dan Farmakokinetik Ceftriaxone ............................ 25
2.5.3 Penggunaan Teraupetik Ceftriaxone pada Pneumonia Komuniti ................ 25
2.5.4 Dosis Ceftriaxone ...................................................................................... 26
2.5.5 Efek samping obat ..................................................................................... 27
2.5.6 Ceftriaxone di Indonesia ............................................................................ 27
BAB III KERANGKA KONSEPTUAL .......................................................................... 31
3.1 Bagan Kerangka Konseptual ............................................................................... 31
3.2 Bagan Kerangka Operasional .............................................................................. 33
BAB IV METODE PENELITIAN .................................................................................. 34
4.1 Rancangan Penelitian .......................................................................................... 34
4.2 Bahan Penelitian ................................................................................................. 34
4.2.1 Kriteria Inklusi .......................................................................................... 34
4.2.2 Kriteria Ekslusi .......................................................................................... 34
4.3 Sampel Penelitian ................................................................................................ 34
4.4 Instrumen Penelitian............................................................................................ 34
4.5 Tempat dan Waktu Penelitian .............................................................................. 35
4.6 Definisi Operasional............................................................................................ 35
4.7 Prosedur Pengumpulan Data ............................................................................... 36
4.8 Analisis Data ....................................................................................................... 36
BAB V HASIL PENELITIAN ........................................................................................ 37
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5.1 Jumlah Sampel Penelitian.................................................................................... 37
5.2 Data Demografi Pasien ........................................................................................ 37
5.2.1 Distribusi Berdasarkan Jenis Kelamin ......................................................... 37
5.2.2 Distribusi Berdasarkan Usia ....................................................................... 38
5.2.3 Status Pasien ............................................................................................. 38
5.2.4 Distribusi Perokok Pada Pasien Pneumonia Komunitas .............................. 38
5.3 Penyakit Penyerta ................................................................................................ 39
5.4 Terapi Antibiotika Yang Diterima Pasien Pneumonia Komunitas ........................ 40
5.4.1PolaPenggunaan Ceftriaxone Tunggal Yang Diterima Pasien Pneumonia
Komunitas di Instalasi Rawat Inap ........................................................... 40
5.4.2Pola Penggunaan Ceftriaxone Pada Kombinasi Dua Antibiotika Yang
Diterima Pasien Pneumonia Komunitas di Instalasi Rawat Inap ................... 41
5.4.3Pola Penggunaan Ceftriaxone Pada Tiga Kombinasi Antibiotika Yang
Diterima Pasien Pneumonia Komunitas di Instalasi Rawat Inap ................... 42
5.4.4Pola Penggunaan Ceftriaxone Pada Empat Kombinasi Antibiotika Yang
Diterima Pasien Pneumonia Komunitas di Instalasi Rawat Inap ................... 43
5.5 Profil Switching Rute, Dosis dan Jenis Pada Ceftriaxone ..................................... 43
5.6 Terapi Lain Yang Diterima Pasien Pneumonia Komunitas .................................. 45
5.6.1Distribusi Terapi Lain Yang Diterima Pasien Pneumonia Komunitas di
Instalasi Rawat Inap ..................................................................................... 45
5.7 Lama Penggunaan Ceftriaxone Yang Diterima Pasien Pneumonia Komunitas di
Instalasi Rawat Inap ............................................................................................ 47
5.8 Lama Rawat Inap Pasien Pneumonia Komunitas di Instalasi Rawat Inap ............. 47
5.9 Profil Pasien Pneumonia Komunitas dengan Kondisi Meninggal ......................... 48
BAB VI PEMBAHASAN ............................................................................................... 49
BAB VII KESIMPULAN DAN SARAN ........................................................................ 60
7.1 Kesimpulan ......................................................................................................... 60
7.2 Saran ................................................................................................................... 60
DAFTAR PUSTAKA ..................................................................................................... 61
DAFTAR LAMPIRAN................................................................................................... 66
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DAFTAR TABEL
Tabel Halaman
II.1 Klasifikasi dan Faktor Resiko Pneumonia ........................................................... 10
II.2 Manifestasi Klinis Pneumonia ............................................................................. 12
II.3 Jenis Obat dan Dosis pada Pneumonia ................................................................. 14
II.4 Antibiotika pada Terapi Empiris Pneumonia Komunitas...................................... 18
II.5 Terapi Empiris Pneumonia Komunitas Rawat Inap .............................................. 19
II.6 Terapi Empirik Antibiotika untuk Pneumonia Komunitas pada pasien Pediatri .... 20
II.7 Antibiotik pada Terapi Empiris Pneumonia Nosokomial ..................................... 22
II.8 Terapi Empiris Pneumonia Nosokomial .............................................................. 23
II.9 Tabel Ceftriaxone di Indonesia ............................................................................ 27
V.1 Distribusi Berdasarkan Jenis Kelamin Pasien Pneumonia Komunitas di Instalasi
Rawat Inap Rumah Sakit Umum Karsa Husada Batu Periode 1 Januari sampai 31
Maret 2015 ......................................................................................................... 37
V.2 Distribusi Berdasarkan Jenis Kelamin dan Umur Pasien Pneumonia Komunitas di
Instalasi Rawat Inap Rumah Sakit Umum Karsa Husada Batu Periode 1 Januari
2015 sampai 31 Maret 2015 ............................................................................... 38
V.3 Status Pasien Pneumonia Komunitas di Instalasi Rawat Inap Rumah Sakit Umum
Karsa Husada Batu Periode 1 Januari 2015 sampai 31 Maret 2015 ...................... 38
V.4 Distribusi Pasien Perokok Pneumonia Komunitas di Instalasi Rawat Inap Rumah
Sakit Umum Karsa Husada Batu Periode 1 Januari 2015 sampai 31 Maret 2015.. 38
V.5 Distribusi Penyakit Penyerta Pasien Pneumonia Komunitas di Instalasi Rawat
Inap Rumah Sakit Umum Karsa Husada Batu Periode 1 Januari 2015 sampai
31 Maret 2015 ..................................................................................................... 39
V.6 Pola Penggunaan Ceftriaxone Yang Diterima Pasien Pneumonia Komunitas di
Instalasi Rawat Inap Rumah Sakit Umum Karsa Husada Batu Periode 1 Januari
2015 sampai 31 Maret 2015 ................................................................................ 40
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V.7 Pola Penggunaan Ceftriaxone Tunggal Yang Diterima Pasien Pneumonia
Komunitas di Instalasi Rawat Inap Rumah Sakit Umum Karsa Husada Batu
Periode 1 Januari 2015 sampai 31 Maret 2015 ..................................................... 40
V.8 Pola Penggunaan Ceftriaxone dengan Antibiotika Lain Yang Diterima Pasien
Pneumonia Komunitas di Instalasi Rawat Inap Rumah Sakit Umum Karsa
Husada Batu Periode 1 Januari 2015 sampai 31 Maret 2015 ................................ 41
V.9 Pola Penggunaan Ceftriaxone dengan Kombinasi Antibiotika Lain Yang
Diterima Pasien Pneumonia Komunitas di Instalasi Rawat Inap Rumah Sakit
Umum Karsa Husada Batu Periode 1 Januari 2015 sampai 31 Maret 2015 .......... 42
V.10 Pola Penggunaan Ceftriaxone dengan Tiga Kombinasi Antibiotika Lain Yang
Diterima Pasien Pneumonia Komunitas di Instalasi Rawat Inap Rumah Sakit
Umum Karsa Husada Batu Periode 1 Januari 2015 sampai 31 Maret 2015 .......... 43
V.11 Pola Penggunaan Switching Rute, Dosis dan Jenis Pada Ceftriaxone Yang
Diterima Pasien Pneumonia Komunitas di Instalasi Rawat Inap Rumah Sakit
Umum Karsa Husada Batu Periode 1 Januari 2015 sampai 31 Maret 2015 .......... 43
V.12 Jumlah dan Persentase Masing-Masing Jenis Terapi Tambahan Yang Diterima
Pasien Pneumonia Komunitas di Instalasi Rawat Inap Rumah Sakit Umum Karsa
Husada Batu Periode 1 Januari 2015 sampai 31 Maret 2015 ................................ 45
V.13 Distribusi LamaPenggunaan Ceftriaxone Yang Diterima Pasien Pneumonia
Komunitas di Instalasi Rawat Inap Rumah Sakit Umum Karsa Husada Batu
Periode 1 Januari 2015 sampai 31 Maret 2015 ..................................................... 47
V.14 Jumlah dan Persentase Lama Rawat InapPasien Pneumonia Komunitas di
Instalasi Rawat Inap Rumah Sakit Umum Karsa Husada Batu Periode 1 Januari
2015 sampai 31 Maret 2015 ................................................................................ 47
V.15 Jumlah dan Persentase Pasien Pneumonia Komunitas Yang Meninggal di
Instalasi Rawat Inap Rumah Sakit Umum Karsa Husada Batu Periode 1 Januari
2015 sampai 31 Maret 2015 ................................................................................ 48
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DAFTAR GAMBAR
Gambar Halaman
2.1 Pneumonia ............................................................................................................ 6
2.2 Struktur Kimia Pneumonia .................................................................................. 25
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DAFTAR LAMPIRAN
Lampiran Halaman
1 Daftar Riwayat Hidup .................................................................................................. 66
2 Surat Pernyataan .......................................................................................................... 67
3 Keterangan Kelayakan Etik .......................................................................................... 68
4 Jadwal Penelitian ......................................................................................................... 69
5 Anggaran Biaya ........................................................................................................... 70
6 Tabel Data Induk.......................................................................................................... 71
xiii
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