Rational Use Of Antibiotics

Antibiotics are one of the most commonly used drug classes in the health sector. As the name implies, drugs in this class are used to fight various bad germs or microorganisms (especially bacteria) that enter the body.

This class of drugs works in various ways to prevent germs from growing or damage the function of some parts of the bacteria so that the immune system is easier to get rid of. However, recently an incident occurred where most types of antibiotics were no longer able to have an effect on germs. This event is known as antibiotic resistance. Antibiotics cannot be given arbitrarily to certain patients, so the rationality of antibiotics is needed. Antibiotics that are resistant will not be able to damage certain structures of bacteria so that bacteria can grow in the body and make the course of a disease continue. For this condition, it is necessary to give antibiotics from certain groups that have a higher effectiveness against bacteria (sensitive). The emergence of resistance to certain antibiotics arises because of inadequate and unmeasured antibiotic administration and inappropriate (irrational) administration.

Antibiotic rationality refers to the administration of antibiotics according to the indications, according to the dose, and according to the duration of administration. To find out how to administer antibiotics rationally, we must first understand the Principle of Giving Antibiotics.

Principles of Administration of Antibiotics

In the process of administering antibiotics, there are several principles that we must be aware of and apply in our daily practice. These principles are:

Antibiotics are not an antipyretic (fever reducer). An increase in temperature alone is not an indication for antibiotics.

It is recommended that before starting antibiotic therapy, try to isolate the pathogen from the focus of infection.

If antibiotics do not take effect for 3-4 days, consider the following possibilities:

1. The class of antibiotics given is not right
2. The drug given does not reach the site or focus of infection
3. Failure to identify the causative pathogen (e.g. viral, fungal or parasitic infection)
4. Abscess, and
5. Ineffective immune system

If antibiotics are no longer needed, stop immediately. The duration of antibiotic use is directly proportional to the danger it provides. The longer antibiotics are used, the more likely the antibiotic is resistant, the greater the toxicity, and the greater the side effects. Many topical antibiotics can be replaced with antiseptics. In fever with unknown origin, blood cultures should be used. done for proper administration of antibiotics

In patients who show symptoms of systemic infection (even without fever), a blood culture should also be performed so that antibiotics are appropriate. In some surgeries a single dose of antibiotics is sufficient.

Antibiotic sensitivity based on the antibiogram does not necessarily mean that a sensitive antibiotic is an effective antibiotic. More than 20% of the results show false positives or false negatives due to the limitations of antibiotic sensitivity testing methods and non-standardized bacteriology laboratories.

The method of sampling from the focus of infection and its transport (media) is very important in assisting the diagnosis and proper use of antibiotics.

Antibiotics are often given for longer than needed. In most diseases, antibiotics 3-5 days after fever is sufficient.

Do not change antibiotics too quickly. Even the best combination antibiotics take 2-3 days to make the body temperature return to normal.

Keep the antibiotics that have shown good results when you use them. Sometimes newer antibiotics are more expensive and are only useful for certain indications.

Don't let drug company representatives or glossy brochures distract you from your good practice and clinical experience with using standard antibiotics (eg penicillin, cotimoxazole, erythromycin, tetracycline).

Rule out allergies before giving antibiotic therapy. Many patients are allergic to penicillin even without a previous history of allergy.Watch for possible drug interactions if given concurrently with antibiotics.

In addition to the principles of giving antibiotics above, there are several mistakes that often occur in the administration of antibiotics, namely:

1. Using broad-spectrum drug classes while narrow-spectrum drugs are actually sufficient
2. Excessive duration of therapy
3. Administration of intravenous therapy when oral therapy is actually as effective as intravenous
4. Combining antibiotics when single antibiotic therapy is adequate
5. Failure to change antibiotics based on test results sensitivity to available antibiotics
6. Failure to adjust the dose in cases of patients with decreased liver or kidney function
7. Not knowing the latest knowledge related to antibiotic resistance, so prescribing the wrong agent in certain diseases
8. Often assumes a case is a bad or severe case. For example, always use combination antibiotics for pathogens such as Pseudomonas

Changes in antibiotic therapy always occur due to the simultaneous development of antibiotic resistance and the emergence of new pathogens

So a doctor must always update his knowledge of antibiotic therapy so that the rationality of antibiotics can be achieved and reduce the number of pathogens that are resistant to certain antibiotics.

Reference: Frank U and Tacconelli E. The Daschner Guide to In-Hospital Antibiotic Therapy. 2nd Edition. Springer Medizin Verlag Heidelberg. 2012