International Journal of Applied Pharmaceutics ISSN - 0975 - 7058 Vol 13, Special Issue 1, 2021 IMPACT OF ANTIMICROBIAL STEWARDSHIP PROGRAM ON THE USE OF ANTIBIOTICS IN PNEUMONIA PATIENTS AT TEACHING HOSPITAL IN SURAKARTA INDONESIA HIDAYAH KARUNIAWATI*, TRI YULIANTI, DEWI KUROTA AINI, FINISHIA ISNA NURWIENDA ABSTRACT Objective: Antibiotic resistance is a serious problem worldwide. One cause of antibacterial resistance is the inappropriate use of antibiotics. The study of antibiotic use in hospitals found that 30–80% were not based on indications. Antimicrobial Stewardship Programs (ASP) was developed to control antimicrobial resistance. This study aims to evaluate the impact of ASP in pneumonia patients qualitatively and quantitatively pre-post ASP applied. Methods: This research is a non-experimental study. Data were taken from the medical records of pneumonia patients and analyzed qualitatively using the Gyssens method and quantitatively using the Defined Daily Dose (DDD) method. Sampling was conducted through purposive sampling and results were described descriptively. Results: During the study period, 96 samples were obtained with 48 data pre-ASP and 48 data post-ASP. The results of the qualitative analysis using the Gyssens method show an increase in the prudent use of antibiotics from 31.25% to 62.5% pre-post ASP, respectively. Quantitative evaluation shows a decrease of antibiotic use pre-post ASP from 90.84 DDD/100 patients-days to 61.42 DDD/100 patients-days. Conclusion: The ASP can improve the quality of antibiotic use in pneumonia patients quantitatively and qualitatively. Keywords: Antimicrobial stewardship program, Gyssens, Pneumonia, Quantitative, Qualitative. INTRODUCTION Antibiotics resistance has become a serious problem worldwide. The acceleration of the discovery of new antibiotics cannot equal the acceleration of bacterial resistance to antibiotics. The cause of bacterial resistance to antibiotics is inappropriate or irrational use of antibiotics [1,2]. About 40–62% found inappropriate use of antibiotics against diseases that should not require antibiotics, whereas in the study of antibiotic use in hospitals it was found that 30–80% were not based on indications [3]. Poor knowledge and misunderstanding of antibiotic treatment are also factors in the increased occurrence of resistance [4]. Efforts to prevent antibiotic resistance have been launched both internationally and nationally. Antimicrobial stewardship program (ASP) in hospitals aims to optimize antimicrobial prescribing to obtain optimal use of antibiotics, prevents the development of antibiotic resistance, improves individual patient care as well as reduce hospital costs, and slows the spread of antimicrobial resistance [5]. Based on Indonesian Health Ministry regulations concerning ASP in hospitals, this program is an attempt to control antimicrobial resistance through preventing selective pressure by applying prudent use of antibiotics and prevents spreading by implementing infection control prevention (Proton Pump Inhibitors) [6]. To find out the effectiveness of the ASP program, it is necessary to evaluate the use of antibiotics in hospitals. Surveillance study of antibiotic use was carried out quantitatively and qualitatively, pre-post ASP. Indicator of antibiotic use in hospitals quantitatively is through evaluating the reduction in the quantity of antibiotic use. The Defined Daily Dose (DDD)/Anatomical Therapeutic Chemical (ATC) method has been recommended by the WHO for the evaluation of antibiotic use. The advantage of this method is that there is no influence from price changes, dosage forms, and easy for comparison at the institutional to international level [7], while the qualitative indicator used is the Gyssens algorithm. Gyssens algorithm consists of questions that classified to compile and simplify the evaluation process; therefore, it helps in categorizing antibiotic prescribing [8]. One of the infectious diseases with high occurrence and cause of death in Indonesia is pneumonia. The prevalence of death due to pneumonia in Indonesia is around 1.8–4.5% in 2013 [9]. The incidence of pneumonia in Central Java has reached 26.76%. During the past 10 years, there has been an increase in pneumococcal resistance, especially against penicillin. Increased resistance to penicillin is also predicted to have an impact on increasing resistance to several classes of antibiotics such as cephalosporin, macrolide, tetracycline, and cotrimoxazole [10]. METHODS Study design This research is a non-experimental study. This study used medical records taken from the teaching hospital. Collected data were analyzed qualitatively using the Gyssens method and quantitatively using the DDD method. DDD is the average daily dose of antibiotic use in adults. Tools and materials The tools used in the study are Gyssens diagram, clinical practice guidelines, Guidelines for Diagnosis and Management of Community and Nosocomial Pneumonia in Indonesia at PDPI (Persatuan Dokter Paru Indonesia), Informasi Obat Nasional Indonesia (2017), and the WHO Collaborating Center for Drug Statistics Methodology. Data were obtained from the medical records of pneumonia patients. Before the study was conducted, research approval was obtained from the health research ethics committee, the medical faculty of Universitas Muhammadiyah Surakarta No.1912/B.1/KEPK-FKUMS/ II/2019. Full Proceeding Paper © 2021 The Authors. Published by Innovare Academic Sciences Pvt Ltd. This is an open access article under the CC BY license (http://creativecommons. org/ licenses/by/4.0/) DOI: http://dx.doi.org/10.22159/ijap.2021.v13s1.Y0067. Journal homepage: https://innovareacademics.in/journals/index.php/ijap Faculty Pharmacy Universitas Muhammadiyah Surakarta, Indonesia. Email: hk170@ums.ac.id Received: 09 December 2019, Revised and Accepted: 25 January 2020 5 th International Conference on Pharmacy and Pharmaceutical Science (ICPPS) 2020