No No
Dosis Frekuen si
Durasi Diagnosa
1 1702 30
NF P
umum Perem
puan
bpjs Perem
puan
4 thn 11 kg 110 – 183,3 mg
Thiamphenicol 175 mg/ pulv
bpjs Perem
puan
bpjs Perem
No No
Dosis Frekuen si
Durasi Diagnosa
13 1799 64
GA P
bpjs Perem
puan
bpjs Perem
No No
Dosis Frekuen si
Durasi Diagnosa
25 1808 84
AE A
bpjs perem
puan
bpjs perem
puan
No No RM
Na ma
Jaminan Kesehata n
Jenis Kelam in
Umur Berat Badan
Dosis 1xp Jenis Antibiotik
Dosis Frekuen si
Durasi Diagnosa
37 0786 64
M W
bpjs Laki-laki
5 thn 14 kg 140 – 242 mg Eritromycin sr 250 3x1 5 hari bronkitis
38 1813 65
KN K
bpjs perem
puan
1 thn 7 kg 21 – 42 mg cefixime sirup 100/5ml 40 mg
2x2 ml 7 hari ISPA
39 1793 41
S bpjs perem
puan
1 thn 10 kg 30 – 60 mg cefixime sirup 100/5ml 40 mg
2x2 ml 7 hari ISPA
40 1795 90
YC bpjs perem puan
7 thn 16 kg 48 – 96 mg cefixime sirup 100/5ml 75 mg
2x3,75 ml
4 hari ISPA
41 0973 41
MF A
bpjs laki-laki
1 thn 10 kg 30 – 60 mg cefixime sirup 100/5ml 40 mg
2x2 ml 7 hari ISPA
42 1654 78
NA jkd laki-laki
5 thn 13 kg 39 – 78 mg cefixime sirup 100/5ml 50 mg
2x2,5 ml 6 hari ISPA
43 1337 63
VR umum laki-laki
1,5thn 9 kg 27 – 54 mg cefixime sirup 100/5ml 50 mg
2x2,5 ml 6 hari Bronkhit is 44 1656
79
K jkd perem
puan
12 thn 24 kg 350 – 420 mg Cefadroxil sirup
250/5ml 2x5 ml 6 hari Pnemoni a
45 1793 66
SM bpjs perem puan
16 thn 39 kg 117 – 234 mg cefixime 100 2x1 3 hari sinusitis
46 1342 42
E W
bpjs laki-laki
6 thn 14 kg 140 – 280 mg Isoniazid 150 1x1 180hari Tb 140 – 280 mg Rifampisin 300 1x1 180hari
47 1817 93
SJ Bpjs Laki-laki
5 thn 13 kg 39 – 78 mg cefixime sirup 100/5ml 50 mg
2x2,5 ml 6 hari ISPA
48 1817 95
A M
Bpjs laki-laki
8 thn 21 kg 210 – 350 mg Metronidazol sirup
No No
Dosis Frekuen si
Durasi Diagnosa
49 1819
Bpjs perem
puan
Bpjs perem
No No
Dosis Frekuen si
Durasi Diagnosa
61 1823
No No RM
Na ma
Jaminan Kesehata n
Jenis Kelam in
Umur Berat Badan
Dosis 1xp Jenis Antibiotik
Dosis Frekuen si
Durasi Diagnosa
74 1825 18
TR C
Bpjs Perem
puan
5 thn 15 kg 45 – 90 mg cefixime sirup 100/5ml 2x5 ml 3 hari Pnemoni a
75 1561 55
IN S
Bpjs Perem
puan
2 thn 12 kg 36 – 72 mg cefixime sirup 100/5ml 50 mg
2x2,5 ml 6 hari ISPA
76 1826 67
LR jkd laki-laki
3 thn 10 kg 125 – 250 mg Cefadroxil sirup
125/5ml 2x5 ml 6 hari ISPA
77 1830 96
AA Bpjs Perem puan
6 thn 16 kg 48 – 96 mg cefixime sirup 100/5ml 2x5 ml 3 hari ISPA
78 1197 46
MF Bpjs laki-laki
3 thn 10 kg 125 – 150 mg Cefadroxil sirup
250/5ml 125 mg
2x2,5 ml 12 hari demam tipoid 79 1325
99 E M
Bpjs laki-laki
4 thn 13 kg 162,5 – 195 mg
Cefadroxil sirup
250/5ml 150 mg
2x3 ml 10 hari demam tipoid 80 1831
44
YS jkd laki-laki
5 bln 6 kg 18 - 36 mg cefixime sirup 100/5ml 30 mg
2x1,5 ml 6 hari Pnemoni a
81 1831 50
FS umum laki-laki
4 bln 6 kg 18 - 36 mg cefixime sirup 100/5ml 30 mg
2x1,5 ml 6 hari Dermatit is 82 1832
49
SA Bpjs laki-laki
6 thn 14 kg 42 – 84 mg cefixime sirup 100/5ml 2x5 ml 3 hari faringitis
83 1832 25
PR Bpjs Perem puan
14 thn 35 kg 105 – 210 mg cefixime sirup 100/5ml 2x5 ml 3 hari ISPA
84 1774 55
M N
Bpjs laki-laki
11 bln 9 kg 27 – 54 mg cefixime sirup 100/5ml 50 mg
2x2,5 ml 6 hari Pnemoni a
85 1833 34
KA Bpjs Perem puan
5,5 thn 14,5 kg
No No RM
Na ma
Jaminan Kesehata n
Jenis Kelam in
Umur Berat Badan
Dosis 1xp Jenis Antibiotik
Dosis Frekuen si
Durasi Diagnosa
86 1771 77
J Bpjs laki-laki
8 thn 18 kg 90 – 135 mg cefixime sirup 100/5ml 2x5 ml 3 hari demam tipoid 87 1380
74
I Bpjs Perem
puan
13 thn 30 kg 90 – 180 mg cefixime sirup 100/5ml 2x5 ml 3 hari ISPA
88 1831 23
MF Bpjs laki-laki
6 thn 15,8 kg
79 - 118,5 mg cefixime sirup 100/5ml 2x5 ml 3 hari demam tipoid 89 1835
46
MS Bpjs laki-laki
8 thn 18 kg 225 – 270 mg Cefadroxil sirup
250/5ml 3x2,5 ml 6 hari Bronkhit is 90 1760
51
AN P
Bpjs laki-laki
1,2 thn 9 kg 112,5 – 135 mg
Cefadroxil sirup
125/5ml 2x5 ml 6 hari ISPA
91 1836 17
KP Bpjs perem puan
6 thn 16,2 kg
48,6 - 97,2 mg cefixime sirup 100/5ml 2x5 ml 3 hari Bronkhit is 92 1826
30
KA Bpjs perem puan
3 bln 5,9 kg Amoxan<6 kg,<6 bln 0,5ml-1,0 ml
amoxan drop 100mg/ ml 80 mg
3x0,8 ml 4 hari ISPA
93 1836 37
MF umum laki-laki
2 bln 4,2 kg Amoxan<6 kg,<6 bln 0,5ml-1,0 ml
amoxan drop 100mg/ ml 60 mg
3x0,6 ml 4 hari ISPA
94 1495 44
NA Bpjs laki-laki
8 thn 19 kg 57 – 114 mg cefixime sirup 100/5ml 2x5 ml 3 hari ISPA
95 1816 92
IR Bpjs perem puan
4 bln 6,5 kg Amoxan<6 kg,<6 bln 0,5ml-1,0 ml
amoxan drop 100mg/ ml 60 mg
3x0,6 ml 4 hari Pneumon ia
96 1837 02
SP Bpjs laki-laki
3 thn 11 kg 34 - 68 mg cefixime sirup 100/5ml 50 mg
No No
Dosis Frekuen si
Durasi Diagnosa
97 1833
No No
Dosis Frekuen si
Durasi Diagnosa
10
Bpjs perem
puan
4 thn 13 kg 39 – 78 mg cefixime sirup 100/5ml 2x2,5 ml 50 mg
6 hari Bronkhit is
Bpjs perem
puan
4 thn 12 kg 36 – 72 mg cefixime sirup 100/5ml 2x2,5 ml 50 mg
No No
Dosis Frekuen si
Durasi Diagnosa
12
6 hari faringitis
13 kap max sehari 3 kap
No No
Dosis Frekuen si
Durasi Diagnosa
13
Bpjs perem
puan
6 hari Pneumon ia
Bpjs perem
puan
Bpjs perem
No No RM
Na ma
Jaminan Kesehata n
Jenis Kelam in
Umur Berat Badan
Dosis 1xp Jenis Antibiotik
Dosis Frekuen si
Durasi Diagnosa
14 6
1501 28
RY bpjs laki-laki
11 thn 25 kg 375 – 625 mg Thiamphenicol 500 3x1 5 hari Bronkhit is 14
7
1160 16
H bpjs laki-laki
4,8 thn 13,5 kg
168,75 – 202,5 mg
Cefadroxil sirup
125/5ml 3x5 ml 4 hari Bronkhit is 14
8
1875 00
KS bpjs perem puan
2 thn 9 kg 112,5 – 135 mg
Cefadroxil sirup
125/5ml 3x2,5 ml 6 hari Bronkhit is 14
9
1871 83
LE P
bpjs laki-laki
4 thn 12,5 kg
37,5 – 75 mg cefixime sirup 100/5ml 2x2,5 ml 6 hari Bronkhit is 15
0
1314 54
NA bpjs laki-laki
3 thn 11,5 kg
76,6 – 153 mg amoxicilin sirup
Lampiran 2 Surat Judul Dan Pembimbing I
