scholarly journals A Novel Metric System to Quantify Antibiotic Consumption in Paediatric Population: A Hospital Based, Biphasic Pilot Study

Discoveries ◽  
2020 ◽  
Vol 8 (4) ◽  
pp. e119
Author(s):  
Shah Newaz Ahmed ◽  
◽  
Ratinder Jhaj ◽  
Ritendra Patidar ◽  
Mahendra Dangi ◽  
...  
Keyword(s):  
Body Weight ◽  
Anatomical Therapeutic Chemical ◽  
Adult Population ◽  
Healthcare Delivery ◽  
Paediatric Population ◽  
Antibiotic Consumption ◽  
The Body ◽  
World Health ◽  
Defined Daily Dose ◽  
Standard Unit

Background: The Anatomical Therapeutic Chemical Classification / Defined Daily Dose (ATC/DDD) system recommended by World Health Organization is accepted worldwide as the standard method of quantification of drug consumption. However, owing to individual variation in body weight, the ATC/DDD system cannot be used for comparison across paediatric population. Objective: This study aimed to develop a novel metric system for standard quantification of antibiotic consumption in paediatric population. Method: The standard unit of drug quantification in adult population is DDD/100 patient days (PD). We conceived a new unit of DDD/1000 kg-days (KD) where KD is the product of the body weight and length of hospital stay of an individual patient. We simulated the quantification and comparison of drugs in a computer model of five virtual paediatric hospitals (H1 to H5, n=100, 200, 100, 100, 100 respectively). We re-applied the metric system on two, real world, hospital-based, time cohorts (TC) (TC18, n=38 and TC19, n=47) of 2 weeks each, in two consecutive years. Results: The body weights (mean±SD) in H1-H5 were 5.7±3.0, 5.7±2.8, 25.3±8.5, 20.6±11.7 and 19.8±11.4 kg, respectively. The antibiotic consumption in terms of DDD/100 PD and DDD/1000 KD in the five hospitals was 1.26, 1.20, 5.52, 4.41 and 2.00, and 2.24, 2.14, 2.22, 2.17 and 1.06 respectively. In TC18 and TC19, the mean body weight, DDD/100 PD and DDD/1000 KD were 12.24±13.17, 30.93, 20.34 and 19.51±12.28, 11.99, 6.23, respectively. Conclusion: DDD/1000 kg-days is a potential standard unit for drug quantification in paediatric population independent of weight distribution and size of the study sample. The universal application and comparison across diverse samples can generate useful information for resource allocation, anti-microbial stewardship, disease burden and drug use, and can help in taking policy decisions to improve healthcare delivery in the paediatric population.

scholarly journals Analysis of Antibiotic Use Patterns and Trends Based on Procurement Data of Healthcare Institutions in Shaanxi Province, Western China, 2015–2018

2020 ◽  
Vol 17 (20) ◽  
pp. 7536
Author(s):  
Sen Xu ◽  
Shengfang Yuan ◽  
John Alimamy Kabba ◽  
Chen Chen ◽  
Wenchen Liu ◽  
...  
Keyword(s):  
Quality Indicators ◽  
Anatomical Therapeutic Chemical ◽  
Antibiotic Use ◽  
Antibiotic Consumption ◽  
Shaanxi Province ◽  
Western China ◽  
World Health ◽  
Fourth Generation ◽  
Defined Daily Dose ◽  
Antibiotic Utilization

Overuse of antibiotics has caused a series of global problems, especially in the underdeveloped western regions where healthcare systems are fragile. We used antibiotic procurement data of all healthcare institutions to analyze the total amount, patterns and trends of antibiotic use in Shaanxi Province, western China between 2015 and 2018. Antibiotic utilization was quantified using the standard Anatomical Therapeutic Chemical (ATC)/Defined daily dose (DDD) methodology. The World Health Organization’s “Access, Watch and Reserve” (AWaRe) classification and European Surveillance of Antimicrobial Consumption (ESAC) drug-specific quality indicators were also adopted to evaluate the appropriateness and quality of antibiotic utilization. Overall, antibiotic consumption decreased from 11.20 DID in 2015 to 10.13 DID (DDDs per 1000 inhabitants per day) in 2016, then increased to 12.99 DID in 2018. The top three antibiotic categories consumed in 2018 were J01C (penicillins) 33.58%, J01D (cephalosporins) 29.76%, and J01F (macrolides) 19.14%. Parenteral antibiotics accounted for 27.41% of the total consumption. The largest proportion of antibiotic use was observed in primary healthcare institutions in rural areas, which accounts for 51.67% of total use. Consumption of the Access group, the Watch group, the Reserve group of antibiotics was 40.31%, 42.28% and 0.11%, respectively. Concurrently, the consumption of J01D and the percentage of J01 (DD + DE) (third and fourth generation cephalosporins) were at a poor level according to the evaluation of ESAC quality indicators. The total antibiotic consumption in Shaanxi Province had been on an upward trend, and the patterns of antibiotic use were not justified enough to conclude that it was rational. This is partly because there was high preference for the third and fourth generation cephalosporins and for the Watch group antibiotics.

scholarly journals The Evaluation of Antibiotic Consumption at the Inpatient Level in Kazakhstan from 2011 to 2018

Antibiotics ◽  
2020 ◽  
Vol 9 (2) ◽  
pp. 57 ◽  
Author(s):  
Gulzira Zhussupova ◽  
Galina Skvirskaya ◽  
Vladimir Reshetnikov ◽  
Viktorija Dragojevic-Simic ◽  
Nemanja Rancic ◽  
...  
Keyword(s):  
Antimicrobial Agents ◽  
Anatomical Therapeutic Chemical ◽  
Antibiotic Use ◽  
Generation Cephalosporin ◽  
Antibiotic Consumption ◽  
Essential Medicines ◽  
World Health ◽  
Defined Daily Dose ◽  
Total Consumption ◽  
Systemic Action

Antimicrobial agents have a rather special position due to their importance as essential medicines for the treatment of infectious diseases. Evidence-based prescriptions are needed to optimize the use of antimicrobials in humans, as well as to decrease antimicrobial resistance. The aim of this study was to assess the inpatient consumption of antimicrobial drugs for systemic use in the period 2011–2018 in Kazakhstan. This article presents the results of an evaluation of the inpatient use of antibacterial drugs for systemic use (group J01) for the period 2011–2018 using the anatomical therapeutic chemical (ATC) classification)/defined daily dose (DDD) methodology recommended by the World Health Organization. Inpatient antimicrobial utilization is expressed as DDDs/1000 inhabitants/day (DID). The results of the assessment for inpatient antibiotic use (over an eight-year period) showed a decrease in the total consumption of antibiotics for systemic action in Kazakhstan (2011: 12.72 DID; 2018: 2.74 DID). Among oral formulations, levofloxacin was consumed the most, and cefazolin was consumed the most among the parenteral formulations of antimicrobials. The three drugs consumed the most included cefazolin (first-generation cephalosporin), ceftriaxone (third-generation cephalosporin), and cefuroxime (second-generation cephalosporin). The total consumption of antibacterials for systemic action in Kazakhstan decreased during the analyzed period, but there was an irrational use of certain groups of drugs.

scholarly journals Changing Pattern of Antibiotics Usage Among Hospitalized Patients of a Tertiary Hospital in South Korea: 2004–2013

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S327-S327
Author(s):  
Bongyoung Kim ◽  
Hyeonjun Hwang ◽  
Myoung-Jae Lee ◽  
Jieun Kim ◽  
Hyunjoo Pai
Keyword(s):  
South Korea ◽  
Broad Spectrum ◽  
Anatomical Therapeutic Chemical ◽  
Tertiary Hospital ◽  
Hospitalized Patients ◽  
World Health ◽  
Defined Daily Dose ◽  
University Hospitals ◽  
Stepwise Increase ◽  
Broad Spectrum Antibiotics

Abstract Background This study was performed to evaluate the changing pattern of antibiotics usage among hospitalized patients of tertiary hospital in South Korea. Methods Total antibiotics prescription record of hospitalized patients from 2004 to 2013 were collected at a tertiary university hospitals. The antibiotics is defined as class J01 from anatomical therapeutic chemical classification system (ATC). The consumption of each class of antibiotic was converted to defined daily dose (DDD)/1,000 patient-days by using ATC of World Health Organization. Results Over the 10-year study period, the annual consumption of systemic antibiotics ranged from 815.10 to 1047.96. The proportion of broad-spectrum antibiotics and non-broad-spectrum antibiotics use are as follows: 45.4% (417.55/920.69) vs.. 54.6% (503.15/920.69), respectively. A 16.9% of decrease in total antibiotics consumption was observed in 2013 compared with 2004 (1000.69 in 2004 vs.. 831.46 in 2013). The decrease rate of non-broad spectrum antibiotics usage was 39.3% during the study period (607.21 in 2004 vs. 368.88 in 2013). In contrast, a stepwise increase in consumption of broad-spectrum antibiotics was observed (14.9% of increase; 393.48 in 2004 vs. 462.58 in 2013). Among broad-spectrum antibiotics, a significant decrease trend was observed for third-generation cephaloporins (P < 0.001). In contrast, a significant increase trend was observed for β-lactam/lactamase (P < 0.001). The monthly overall consumption trend of fluoroquinolones and glycopeptides remained stable (P = 0.061; P = 0.107, respectively). In addition, there were significant decrease trends for consumption of non-broad-spectrum antibiotics, including first generation cephalosporins (P = 0.019) and aminoglycosides (P = 0.004). However, the consumption of second generation cephalosporins, imidazole and penicillins showed a stable trend (P = 0.175; P = 320; P = 0.234, respectively). Conclusion A total antibiotics consumption showed significantly decrease trend from 2004 to 2013. In contrast, a stepwise increase in consumption of broad-spectrum antibiotics was observed in the tertiary hospital in South Korea. Disclosures All authors: No reported disclosures.

Comparative evaluation of the seasonal dynamics of live weight of mares of different genotypes

2018 ◽  
Vol 22 (03) ◽  
pp. 33-37
Author(s):  
T F Lefler ◽  
A D Volkov ◽  
Y Y Kolomeets
Keyword(s):  
Body Weight ◽  
Seasonal Dynamics ◽  
Adaptive Dynamics ◽  
Adult Population ◽  
Live Weight ◽  
The Body ◽  
Winter Period ◽  
Temperature Changes ◽  
Horse Breeding ◽  
Feed Temperature

The article presents the results of a study of the adaptive dynamics of a live weight of native mares Khakass groups Orlov trotter, Russian trotter breed and Russian Heavy Draft. In horse breeding at the year-round grazing horses, the main problem associated with adverse to the body of animals and the longest winter tebenevochnym period. Quality wintering herd horses depends largely on the ability to retain fatness (conditionally resistance) during this difficult period. Applied today assessment of the herd of horses that are on tebenevke by visual inspection, does not allow to identify the start of a sharp loss of body weight, as a result of animals are depleted, which leads to an increase in the number of abortions in mares and waste both young and adult population. Investigations were carried out to study the adaptive dynamics of a live weight of mares in a year-round grazing for timely identification of the onset of critical changes. Degree horses adapt to seasonal rhythms in a year-round grazing animals reflects their annual dynamics of live weight. This indicator is one of the criteria for adaptation to breeding conditions. Comparative seasonal dynamics of the live weight of the mares of different genotypes studied by seasons by the formula AA Motorina [1]. During the year, the mares of different genotypes reacted differently to the drastically changing feed, temperature, physiological, and others. Factors. Hardier mare were Khakass groups. They are less than animals of other genotypes, react to the current level of feeding and management, sharp temperature changes. What does the change of body weight in the autumn-winter period (1.0-1.9 vs. 2.5-3.8%), autumn-spring (against 15,9-17,4 17,0-20,9) and autumn-summer (against 10,4-11,3 10,8-13,0%), indicating that a good adaptation mares Khakass groups to environmental factors.

scholarly journals Analyzing Antidiabetes Drug Prescriptions With World Health Organization Anatomical Therapeutic Chemical/Defined Daily Dose Index to Assess Drug Utilization Pattern in Elderly Population of Rural Eastern India

2017 ◽  
Vol 8 ◽  
pp. 117739361770334 ◽  
Author(s):  
Sandeep Lahiry ◽  
Avijit Kundu ◽  
Ayan Mukherjee ◽  
Shouvik Choudhury ◽  
Rajasree Sinha
Keyword(s):  
World Health Organization ◽  
Drug Utilization ◽  
West Bengal ◽  
Anatomical Therapeutic Chemical ◽  
World Health ◽  
Defined Daily Dose ◽  
Prescription Data ◽  
Daily Dose ◽  
Health Organization

Objective: To analyze drug utilization (DU) pattern of antidiabetes drug (ADD) prescription in elderly type 2 diabetes mellitus (T2DM) in rural West Bengal based on 2016 World Health Organization (WHO) Anatomical Therapeutic Chemical/Defined Daily Dose (ATC/DDD) Index. Methods: This was a prospective observational study. Prescription data of 600 elderly patients (age > 60 years) attending outpatient clinic were screened over 12 months (January 2015 to January 2016) from 5 different rural hospitals in West Bengal. Pooled data were sorted and classified in accordance with 2016 ATC/DDD WHO Index. Direct cost associated and consumption of ADD were measured as DDD/1000 patients/day. The adverse drug reactions (ADRs) related to antidiabetic medicines were monitored. Results: During the study period, mean age of patients recorded was 66.4 ± 5.0 years, with 66.6% (n = 396) having history of T2DM > 5 years. Follow-up encounters (n = 2328) revealed metformin (94.67%), sulfonylureas (SUs) (50.54%), pioglitazone (24.22%), voglibose (22.50%), insulin (9.75%), and acarbose (6.82%) to be more prevalent, constituting DU 90% (92.01%). Combination of metformin plus SU was recorded in most of the patients (56%). Insulin, however, was found to be an underutilized class ( P < .005). The DDD/1000 patients/day of metformin (2.918), glimepiride (1.577), and gliclazide (0.069) conformed to 2016 WHO ATC/DDD Index. The total ADD consumption during study period was 5.03 DDD/1000 patients/day. The average drug cost per encounter per day was Rs 11.24 ± 2.01. Nineteen ADRs were reported and their descriptions were found to be of hypoglycemia (n = 9), pedal edema (n = 2), and gastrointestinal upsets (n = 8). Target glycemic status was achieved in 40% monthly follow-up encounters. Low-store drug availability and poor compliance to treatment (>60%) were major determinants. Lack of regular aerobic exercises (>85%) and proper knowledge regarding medical nutrition therapy (MNT) (>80%) and low average consultation time (3.5 ± 0.6 minutes) were important contributing factors. Conclusions: The study exhibited increased utilization of 2 drug combinations of oral ADD and lower utilization of insulin during study period. Such inferences merit further exploration.

scholarly journals Paediatric population pharmacokinetic and pharmacodynamic modelling of ambrisentan in pulmonary arterial hypertension and comparison with adult data

2021 ◽  
Author(s):  
Malek Okour ◽  
Mita Thapar ◽  
Colm Farrell ◽  
Mary Ann Lukas ◽  
Maurice Beghetti ◽  
...  
Keyword(s):  
Body Weight ◽  
Steady State ◽  
Adult Population ◽  
Systemic Exposure ◽  
Paediatric Population ◽  
Walking Distance ◽  
Population Pharmacokinetic ◽  
Paediatric Patients ◽  
Population Pk ◽  
Pulmonary Arterial

Aims: To develop a population pharmacokinetic (PK) model of ambrisentan in paediatric patients aged 8 to <18 years with pulmonary arterial hypertension (PAH), compare paediatric ambrisentan systemic exposure to historical adult data, and assess PK–PD relationships. Methods: A previously developed adult population PK model provided an initial step for modelling the 211 PK observations from 39 paediatric patients with PAH in the randomised Phase IIb study AMB112529 (NCT01332331). Subsequently, a population PK model was developed using only paediatric PK data. Steady-state systemic exposure metrics were estimated for the paediatric population and compared with historical adult data (adult patients with PAH and healthy volunteers). Exploratory exposure–response analysis assessed ambrisentan systemic exposure versus change from baseline in 6-minute walking distance in paediatric patients; findings were compared with adult data. An exploratory analysis of ambrisentan exposure versus incidence of ambrisentan-related adverse events in paediatric patients was also performed. Results: The final paediatric population PK model was a two-compartment model which includes the effect of body weight (allometric scaling), first-order absorption and elimination, and absorption lag time. Similar steady-state ambrisentan exposure was confirmed in paediatric patients and historical adult data when differences in body weight were accounted for. There was no apparent correlation in the paediatric or adult population between ambrisentan exposure and change in 6-minute walking distance, or between ambrisentan exposure and incidence of ambrisentan-related adverse events in paediatric patients. Conclusions: Similar ambrisentan exposure and PK–PD profiles were observed in paediatric and adult populations with PAH.

scholarly journals Amelioration of complete Freund’s adjuvant-induced arthritis by Calotropis procera latex in rats

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Roshni Patel ◽  
Shahrukh Kadri ◽  
Priyanshee Gohil ◽  
Shrikalp Deshpande ◽  
Gaurang Shah
Keyword(s):  
Body Weight ◽  
Bone Erosion ◽  
Hematological Parameters ◽  
Adult Population ◽  
The Body ◽  
Complete Freund’S Adjuvant ◽  
Calotropis Procera ◽  
Freund’S Adjuvant ◽  
Complete Freund's Adjuvant ◽  
Freund's Adjuvant

Abstract Background Rheumatoid arthritis is the most common cause of disability, affecting 0.3–1% of the adult population worldwide. The latex of Calotropis procera possesses potent anti-inflammatory as well as analgesic properties. In light above facts, the present study was designed to evaluate anti-arthritic activity of Calotropis procera latex in complete Freund's adjuvant (CFA)-induced arthritis in Wistar albino rats. Complete Freund's adjuvant was injected into the left hind paw on day 0, and treatment of prednisolone and Calotropis procera latex was given from day 0 to 28. Various biochemical, hematological and functional parameters as well as radiological and histopathological changes of joint along with body weight and paw volume were measured. Results Calotropis procera treatment significantly lowered paw volume in CFA-induced arthritic rats. Significant improvement was observed in functional, biochemical and hematological parameters in Calotropis procera-treated rats. However, the body weight remained unaffected. Histological and radiographical examination of synovial joints in Calotropis procera-treated animals exhibited less synovial hyperplasia, infiltration and accumulation of inflammatory cell in synovial fluid, cartilage and bone erosion and joint space narrowing. Conclusion Calotropis procera latex possesses anti-arthritic activity, which is facilitated by modulation in the level of inflammatory mediators and oxidative stress. The improvement in hematological as well as biochemical parameters might be reflected on functional, histopathological, radiological changes and thereby disease progression.

scholarly journals Reference Equations for Spirometry Healthy Adult Population in Brazil

2020 ◽  
Author(s):  
mariane campos ◽  
Wagner Luis Ripka ◽  
Leandra Ulbricht
Keyword(s):  
Prediction Models ◽  
Adult Population ◽  
The Body ◽  
Metropolitan Region ◽  
World Health ◽  
Chronic Obstructive ◽  
Cross Sectional ◽  
White Skin ◽  
Selection Of Variables ◽  
Effective Diagnosis

Abstract Background Chronic Obstructive Pulmonary Disease (COPD) is a set of diseases, has as its main characteristics a limitation of the ventilatory flow. The World Health Organization (WHO) estimates that by 2030, COPD will be the third-largest cause of death. However, for the effective diagnosis, it is necessary to use reference curves appropriate to the population in which the individual belongs, thus it is possible to identify probable limits and abnormalities.Methods This is a cross-sectional and retrospective study conducted in a metropolitan region comprising 29 municipalities in southern Brazil. Individuals of both genders aged between 18 and 59 years, non-smokers, self-identified with white skin, participated in the study. The spirometric collections were done following the American Thoracic Society guidelines. And beyond them, mass and height were collected for determination of the Body Mass Index. The correlations between pulmonary and anthropometric variables were tested by regression analysis univariate after the selection of variables through multivariate analysis and logarithmic regression.Results In this sample, 800 participants were evaluated, of these 533 females and 267 males. Both sexes had considerable spirometry variables values as FVC, FEV6, and FEV1, used in the development of prediction models. The only variable, with a positive correlation in both genders, was height. For the males model, the best fit variable was FVC, with R 2 = 0.417 and for females FEV, with R 2 = 0.462. Among males, was seeing a lower value for all individuals in both variables. Whereas women had similar behavior, for CVS, with slight differences in the ends of the curves, comparing FEV1, the values were higher in all evaluated.Conclusion The prediction equations showed the previous curves were very restrictive and could be leading to false-positives. Thus, this update in the reference values would support clinical decisions on the prevention, diagnosis, and treatment of COPD.

scholarly journals Variability between health areas in antibiotic consumption among pediatric outpatients of Principado de Asturias, Spain (2005-2018)

2021 ◽  
Author(s):  
Laura Calle-Miguel ◽  
◽  
Gracia Modroño Riaño ◽  
Ana Isabel Iglesias Carbajo ◽  
María Agustina Alonso Álvarez ◽  
...  
Keyword(s):  
Anatomical Therapeutic Chemical ◽  
Pediatric Population ◽  
Antibiotic Consumption ◽  
High Variability ◽  
Defined Daily Dose ◽  
Health Area ◽  
Consumption Rates ◽  
Pediatric Outpatients ◽  
Using Data ◽  
Community Sector

Background. Antibiotics in Spain are mainly prescribed in the community sector, remarking a high variability between areas. The aim of this study is to describe the variability between health areas in the antibiotic consumption in the pediatric population of Asturias during 2005-2018 period. Methods. Retrospective and comparative study using data about consumption of antibacterial agents for systemic use (J01C group in ATC, Anatomical Therapeutic Chemical, classification) in the pediatric outpatients of the eight health areas of Principado de Asturias between 2005 and 2018, based on defined daily dose (DDD) per 1000 inhabitants and day (DID). Results. Mean antibiotic consumption in pediatric outpatients in Principado de Asturias (2005-2018) was 14 DID (CI95% 13.4 – 14.6). Consumption increased until 2009 (15.2 DID) and decreased from 2015 onwards (11.9 DID in 2018). β-lactam penicillins was the most consumed therapeutic group (10.7 DID). There were statistically significant differences among the areas with the highest and the lowest consumption rates (Avilés, 19 DID; Oviedo, 11.5 DID). A high variability between health areas was observed when analysing data temporally (difference of 11.8 DID in 2011) and therapeutic groups. The consumption of macrolides in Langreo health area and quinolones in Jarrio health area were 2.3 and 4.1 times higher, respectively, comparing to Gijón health area. Conclusions. There is a wide quantitative and qualitative variability of antibiotic consumption in the pediatric outpatients among the different health areas of Asturias.

scholarly journals Gambaran Penggunaan Antibiotik di Bangsal Penyakit Dalam RSUD Bangil Kabupaten Pasuruan

2020 ◽  
Vol 5 (1) ◽  
pp. 12
Author(s):  
Sinta Rachmawati ◽  
Rizki Laili Fazeri ◽  
Ika Norcahyanti
Keyword(s):  
World Health Organization ◽  
Anatomical Therapeutic Chemical ◽  
World Health ◽  
Defined Daily Dose ◽  
Daily Dose ◽  
Health Organization

<p>Penggunaan antibiotik yang tidak tepat akan berdampak terhadap terjadinya resistansi. Oleh karena itu, studi penggunaan antibiotik perlu dilakukan di fasilitas pelayanan kesehatan, termasuk rumah sakit. Penelitian ini bertujuan untuk mengetahui gambaran penggunaan antibiotik di bangsal penyakit dalam Rumah Sakit Umum Daerah (RSUD) Bangil Kabupaten Pasuruan dengan menggunakan metode<em> Anatomical Therapeutic Chemical</em> (ATC)/<em>Defined Daily Dose</em> (DDD). ATC/DDD adalah metode perhitungan penggunaan antibiotik secara kuantitatif yang direkomendasikan oleh <em>World Health Organization</em> (WHO). Pengambilan data dilakukan secara retrospektif menggunakan sumber data excel berupa rekapitulasi rekam medik. Populasi pada penelitian ini adalah seluruh pasien rawat inap dewasa di bangsal penyakit dalam sepanjang tahun 2017. Sejumlah 973 data dari keseluruhan populasi memenuhi kriteria inklusi. Analisis data dilakukan berdasarkan pada karakteristik pasien, profil antibiotik dan perhitungan kuantitatif dengan metode ATC/DDD. Hasil penelitian menunjukkan bahwa golongan antibiotik yang paling banyak digunakan adalah golongan sefalosporin sebesar 51,41%, sedangkan jenis antibiotik yang paling banyak diresepkan yaitu ceftriaxone dengan jumlah sebesar 25,86%. DDD/100 <em>patient-days</em> tertingi adalah ceftriaxone dengan nilai 27,79 DDD/100 <em>patient-days</em>. Perlu dilakukan penelitian lanjutan dengan menggunakan metode Gyssens untuk mengetahui rasionalitas penggunaan antibiotik.</p>

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