Prosiding Simposium LxxiV A to Z about infections pediatric antibiotic stewardship
Penggunaan Antibiotik Profilaksis untuk Pencegahan Infeksi Daerah Operasi pada Anak
menurun menjadi 0,6%. Pemberian APP dalam kurun waktu 3 jam pasca insisi mengurangi risiko IDO menjadi 2,1%, sedangkan pemberian APP sesudah 3 jam pasca insisi mengurangi risiko IDO menjadi sebesar 5,8%.(21)
Secara umum pemberian APP cukup satu kali. Untuk memastikan kadar antibiotik pada serum dan jaringan cukup, pengulangan dosis APP diperlukan jika durasi operasi melebihi dua kali waktu paruh antibiotik atau terdapat perdarahan massif (>1500 mL pada dewasa). Pengulangan APP juga direkomendasikan pada keadaan yang menyebabkan waktu paruh antibiotik memendek seperti pada pasien yang mengalami luka bakar masif. Pengulangan dosis APP tidak diperlukan pada pasien yang mengalami pemanjangan waktu paruh antibiotik seperti pada pasien dengan gangguan fungsi ginjal. Pada operasi bersih dan bersih terkontaminasi, tidak direkomendasikan untuk memberikan tambahan APP setelah luka insisi bedah ditutup di kamar operasi walaupun terdapat drain dan menggunakan prostesis pada sendi.(15,16,20) Pemberian antibiotik lebih dari 24 jam meningkatkan risiko terjadinya infeksi Clostridium difficile (Rasio Odds 3,74).(22) Pemberian APP 24-48 jam hanya diperbolehkan pada keadaan khusus seperti pemasangan shunt internal dan operasi cardiotoraks (extended prophylaxis).(20)
Tabel 3. Rekomendasi dosis dan jarak pengulangan dosis(16,19)
Antibiotik Dosis anak Lama
pemberian Waktu
paruh Durasi pengulangan Ampicillin/
Sulbactam 50 mg/kg (maks 2g) komponen ampisilin 30 menit 0.8–1.3 jam tiap 2 jam Cefazolin 30 mg/kg (maks 2g, 3g untuk pasien BB≥
120 kg) 30 menit 1,2–2,2 jam tiap 4 jam
Cefuroxime 50 mg/kg (maks 1,5g) 30 menit 1-2 jam tiap 4 jam
Ceftriaxone 50–75 mg/kg, (maks 2g) 60 menit 5,4–10,9 jam NA
Cefotaxim 50 mg/kg (maks 1g) 30 menit 0,9–1,7 jam tiap 4 jam
Cefepime 50 mg/kg (maks 2g) 30 menit NA Tiap 4 jam
Clindamycin 10 mg/kg (maks 900 mg) 30 menit 2-4 jam Tiap 6 jam
Gentamicin 2.5 mg/kg (maks 5 mg/kg) dosis tunggal 30 menit 2-3 jam Tiap 8 jam Metronidazole IV: 15 mg/kg (maks 500 mg), neonatus BB<
1200 g 7,5 mg/kg, dosis tunggal PO: 15 mg/kg (maks 1 g)
30 menit 6-8 jam
6-10 jam Tiap 6 jam NA
Vancomycin 15 mg/kg (maks 15 mg/kg) 60 menit 4-8 jam Tiap 6 jam
Simpulan
Pemilihan dan pemberian APP yang tepat dan bijaksana dapat menurunkan risiko IDO dan mengurangi risiko terjadinya efek samping dan resistensi antibiotik.
Prosiding Simposium LxxiV A to Z about infections pediatric antibiotic stewardship
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