Universitas Indonesia Conferences, Asian Federation for Pharmaceutical Sciences (AFPS) 2019

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The Effectiveness of Clinical Pathway Implementation to Prevent Irrational Antibiotic: Based on Diarrhea in Children Cases in A Private Hospital, in Bekasi, West Java
Wawaimuli Arozal

Last modified: 2019-06-15


Background:Irrational use of antimicrobial agents is an emerging issue not only in the world but also in Indonesia, which could lead the anti-microbial resistance. Diarrhea in children is a common case of inappropriate use of antibiotic in Indonesian hospital and one way to overcome this problem is to implement Clinical Pathway, a combination concept of cost control from INA-CBGs’ “case mix” and quality control based on the guidelines from professional medical services.

Objective: This study tries to monitor the rational use of antibiotic in a private hospital in Permata Bekasi, west Java, using rational assessment of antibiotic use analysis

Materials and Methods:Observational and retrospective analysis was conducted for three months in a 282 of Acute Gastro-Enteritis (AGE) in children patient using clinical pathway implementation / CP patients (141 patients) or without using this pathway / non-CP patients (141 patients). The Length of hospital stay, clinical outcome, and antibiotic usage monitoring using Gyssens method and Anatomical Therapeutic Chemical (ATC)/Defined Daily Dose (DDD) method were analysed.

Results:We found the reduced use of anti-fever and anti-emetic drug in the CP patients and increased of zinc-supplementation therapy in those than in the non-CP patients, which was consistent with WHO Diarrhea Guideline in children. Importantly, the use of antibiotic was significantly decreased and the rationality of antibiotic use was increased in CP patients from Gyssens method, and antibiotic use evaluation using ATC/DDD methods was better in CP patients than those in non-CP patients. Both groups showed good clinical outcome, but the length of hospital stay was decreased in CP patients than those in non-CP patients.

Conclusion:This study showed that clinical pathway implementation is an effective and useful approach to increase the rationality of pharmacological treatment particularly in antibiotics use and decrease of the length of hospital stay without affecting clinical outcomes in the clinical setting.



Key words:Clinical Pathway, Irrational Antibiotic, Diarrhea in Children, Length of Hospital Stay, Clinical Outcome