Perbandingan Terapi Antibiotik Ceftriakson Rute Intervena Bolus dan Intravena Drip terhadap Penurunan Kadar Procalcitonin dan Asam Laktat Pasien Sepsis
DOI:
https://doi.org/10.36408/mhjcm.v7i2.499Keywords:
ceftriaxone, intravena bolus, intravena drip, procalcitonin, asam laktatAbstract
Latar belakang: Ceftriaxone merupakan antibiotika golongan bakterisida dan termasuk dalam golongan antibiotic time dependent. Efek bakterisidal yang optimal dari obat ini memerlukan waktu paparan yang lebih lama dibandingkan dengan konsentrasi obat yang tinggi dalam darah (T > MIC). Penelitian ini bertujuan untuk mengkaji perbandingan penurunan kadar procalcitonin dan asam laktat pada pasien sepsis yang mendapat terapi antibiotik ceftriaxone rute intravena bolus dan rute intravena drip.
Metode: Desain penelitian ini merupakan penelitian prospektif cohort, dengan analisa data menggunakan metode analisis komparatif tidak berpasangan. Pengamatan penanda infeksi procalcitonin dan asam laktat pada masing-masing kelompok dilakukan sebanyak tiga kali, yakni berupa data baseline, hari ke 3 dan 5 setelah terapi ceftriaxone diberikan.
Hasil: Nilai rata-rata kadar procalcitonin dan asam laktat sebelum pemberian terapi ceftriaxone pada 15 pasien dengan rute intravena bolus adalah sebesar 23,50 ± 5,59 ng/ml dan 7,17 ± 1,3 mmol/L, sedangkan kadar procalcitonin dan asam laktat pada 15 pasien dengan pemberian ceftriaxone rute intravena drip adalah sebesar 12,98 ± 2,75 ng/ml dan 4,18 ± 1,2 mmol/L. Pada hari ke 3 setelah terapi diberikan, terjadi penurunan kadar procalcitonin dan asam laktat menjadi 14,18 ± 3,21 ng/ml dan 4,68 ± 1,1 mmol/L dengan rute pemberian intravena bolus, sedangkan pada kelompok rute intravena drip menjadi 9,78 ± 2,00 ng/ml dan 3,35 ± 1,7 mmol/L. Pada hari ke 5 setelah pemberian terapi ceftriaxone, kadar procalditonin dan asam laktat menurun menjadi 8,70 ± 2,54 ng/ml dan 2,39 ± 0,14 mmol/L dengan rute intravena bolus, sedangkan dengan rute intravena drip menurun menjadi 5,78 ± 1,38 ng/ml dan 2,85 ± 0,5 mmol/L. Namun, tidak ada perbedaan penurunan procalcitonin dan asam laktat yang bermakna antara kedua kelompok (p>0,05).
Simpulan: Tidak terdapat perbedaan penurunan kadar procalcitonin dan asam laktat pada pasien dengan terapi ceftriaxone rute pemberian intravena bolus ataupun intravena drip.
Kata kunci : ceftriaxone, intravena bolus, intravena drip, procalcitonin, asam laktat.
Abstract
Background : Ceftriaxone is a bactericidal group antibiotic and includes in the time dependent antibiotic class. The optimal bactericidal effect of this drug needs longer exposure time compared to high drug concentrations in the blood (T>MIC). This study aims to analyze procalcitonin and lactic acid levels in septic patients receiving therapy with ceftriaxone with an intravenous bolus and with intravenous drip route.
Methods : This study is a prospective cohort design, data was analysed using unpaired comparative analysis methods. Observation of procalcitonin and lactic acid levels in each group were carried out three times involving baseline, day 3, and day 5 of ceftriaxone administration.
Result : Before treatment, the average value of procalcitonin and lactic acid in 15 patients with ceftriaxone intravenous bolus therapy was 23,50 ± 5,59 ng/ml and 7,17 ± 1,3 mmol/L, whereas in 15 patients with intravenous drip route is 12,98 ± 2,75 ng/ml and 4,18 ± 1,2 mmol/L. On the 3rd and 5th day of ceftriaxone administration, there was a significant reduction (p < 0,05) of procalcitonin and lactic acid levels. There was no significant (p> 0,05) differences of procalcitonin and lactic acid levels between groups.
Conclusion : There is no difference in the reduction of procalcitonin and lactic acid levels among those receiving ceftriaxone intravenous bolus nor intravenous drip administration.
Key word : Ceftriaxone, intravenous bolus, intravenous drip, procalcitonin, lactic acid.
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References
2. Katzung B. Basic and Clinical Pharmacology. 10th Edition. Philadelphia : Lange ; 2012.P:102–5.
3. Grayson ML, Crowe SM, McCarthy JS, Mills J, Mouton JW, Norrby SR, et al. Kucers’ The Use of Antibiotics 1st. 6th Ed. London : Edward Arnold Ltd ; 2010.P:202–7.
4. Shargel L, Wu – pong S, Yu ABC. Applied Biopharmaceutic & Pharmacokinetics. 5th Ed. Boston : McGraw Hill ; 2004.P:136.
5. Robert JA, Boots R, Rickard CM, Thomas P, Quinn J, Roberts DM, et al. Is continuous infusion ceftriaxone better than once a day dosing in intensive care? a randomized controlled pilot study. Journal of Antimicrobial Chemotherapy. 2007 Nov 28,No.59.285–291.
6. Dahlan S M. Statistik Untuk Kodekteran Dan Kesehatan Deskriptif, Bivariat, Dan Multivariat. Jakarta : Salemba Medika ; 2009.98–102.
7. Meisner M. Pathobiochemistry and clinical use of procalcitonin. Clinica Chimica Acta ; Sep 2002, No.323, 2.P:17-29.
8. Raghavan M, Marik PE. Management of sepsis during the early “golden hours”. J Emerg Med. 2006 ; No.31Vol.2.185–99
9. Shiferaw B, Bekele E, Kumar K, Boutin. The role of procalitonin as a biomarker in sepsis, J Infect Dis Epidemiolo. Open Access Journal. 2016 ; Vol2.P:90–94.
10. Wilujeng H. Hubungan konsentrasi laktat darah dengan disfungsi gagal organ multipel pada pasien sepsis yang diukur dengan skor SOFA (sepsis related organ failure assesment). Surakarta : Universitas Sebelas Maret. 2009.
11. Blomkalns AL. Lactat – a marker for sepsis and trauma. EMCREG – International. 2007 ; P:43–49.
12. Huang Y, Carrol KC, Cosgrove SE, Tamma PD. Determining the optimal ceftriaxone mic for triggering extended spectrum ? lactamase confirmatory testing. Journal of Clinical Microbiology : Juni 2014;Vol52No6.P:2228–2230.
13. Abdurrachman, Febrina E, Evaluasi penggunaan antibiotik pada pasien anak penderita demam tifoid di rumah sakit al islam bandung. Farmaka ; Agustus 2018, No.2,16.P:87 – 96.
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