The Rationality of Antibiotic use Based on Qualitative Parameters in Community-acquired Pneumonia Therapy at General Hospital, Indonesia

The use of antibiotics in Community-acquired pneumonia (CAP) patients, apart from being empiric therapy, is also a definitive therapy by the results of antibiotic sensitivity tests on bacteria, so it needs to be evaluated so that the use of antibiotics becomes more rational. This study aims to determine the rationality of antibiotic use based on qualitative parameters and analyze factors that correlate with the clinical outcomes of CAP patients. This study enrolled 94 adult patients diagnosed with CAP based on inclusion and exclusion criteria. CAP patients are hospitalized in the non-VIP ward at Dr. Sardjito General Hospital, Yogyakarta, Indonesia, from September to November 2022. Qualitative evaluation of antibiotics using Gyssens categories. Assessment of antibiotic use in CAP patients based on therapy guidelines and the Carmeli Score. Factors that correlated with the clinical outcomes of CAP patients were analyzed using the bivariate and univariate tests. Empirical antibiotics assessment shows that there was the inappropriate use of antibiotics for indications (0.82%), inappropriate use of antibiotics because there are other safer antibiotics (0.82%), inappropriate use of antibiotics because there are other more effective antibiotics (8.20%), the use of antibiotics was too short (14.75%), the use of antibiotics was too long (0.82%), the use of antibiotics was not in the right dose (4.92%), the timing of antibiotics administration was inappropriate (1.64%), while the appropriate use of antibiotics was 68.03%. Definitive antibiotics assessment shows that there was the inappropriate use of antibiotics for indications (4.81%), inappropriate use of antibiotics because there were other antibiotics with a narrow spectrum (0.96%), inappropriate use of antibiotics because there are other more effective antibiotics (8.65%), the use of antibiotics was too short (20.19%), the interval of antibiotic administration was inappropriate (0.96%), the use of the antibiotics was not in the right dose (7.69%), and the timing of antibiotic administration was inappropriate (2, 89%), while the appropriate use of antibiotics was 53.85%. Factors that correlate with clinical outcomes in CAP patients are BUN levels and CAP severity. The rationality of using antibiotics for empiric therapy was 68.03% and definitive therapy was 53.85%, the most inappropriate use occurred when giving antibiotics for too short a time (20.19%). BUN levels and severity of CAP correlate with clinical outcomes in CAP.