ANTIMICROBIAL RESISTANCE: FOCUSING ON ANTIBIOTIC STEWARDSHIP.pptx

Program Studi S1 Farmasi Universitas Telogorejo Semarang bersama Trinity University of Asia melaksanakan kegiatan Expert Lecture sebagai wujud implementasi kerja sama internasional dalam bidang Tridharma Perguruan Tinggi, khususnya pada aspek pendidikan dan pengajaran. Kegiatan ini menghadirkan dua narasumber, yaitu Apt. Gilang Rizki Al Farizi, M.Farm, dosen Universitas Telogorejo Semarang yang membawakan materi mengenai bijaknya penggunaan antibiotik dalam rangka Antibiotic Stewardship di pelayanan kefarmasian, serta Sir Joseph, RPh dari Trinity University of Asia yang menyampaikan topik tentang dampak penggunaan obat, khususnya antibiotik yang kurang bijak, terhadap pencemaran lingkungan. Kehadiran kedua narasumber memberikan perspektif komprehensif terkait penggunaan antibiotik, baik dari sisi praktik pelayanan kefarmasian maupun isu lingkungan global.

Acara ini diikuti dengan antusiasme tinggi oleh mahasiswa dari kedua universitas. Diskusi interaktif yang berlangsung memperlihatkan semangat mahasiswa dalam menggali wawasan baru sekaligus mengembangkan keterampilan berpikir kritis mengenai isu-isu kefarmasian yang bersifat multidimensional. Melalui kegiatan ini, diharapkan kolaborasi antara Universitas Telogorejo Semarang dan Trinity University of Asia dapat terus berlanjut serta melahirkan berbagai bentuk kerja sama lain yang mendukung pengembangan pendidikan, penelitian, dan pengabdian kepada masyarakat

1. Expert Lecture for the TUA–Universitas Telogorejo Semarang Immersion Program July 24, 2025 universitastelogorejo universitastelogorejo universitastelogorejo.ac.id Prodi S-1 Farmasi dan PSPPA Antimicrobial Resistance: Focusing on Antibiotic Stewardship apt. Gilang Rizki Al Farizi , M.Farm Department of Pharmacy Universitas Telogorejo Semarang

2. universitastelogorejo universitastelogorejo universitastelogorejo.ac.id Prodi S-1 Farmasi dan PSPPA

3. PIN Game: 03099064

4. universitastelogorejo universitastelogorejo universitastelogorejo.ac.id Prodi S-1 Farmasi dan PSPPA Learning Outcome After completing this lecture, students should be able to : Be proficient in understanding the definition of antibiotic resistance Be proficient in understanding the mechanisms of antibiotic resistance and the Post-Antibiotic Effect (PAE) Be proficient in evaluating antibiotic use, both qualitatively and quantitatively

5. universitastelogorejo universitastelogorejo universitastelogorejo.ac.id Prodi S-1 Farmasi dan PSPPA Antimicrobial resistance VS Bacterial Resistance

6. universitastelogorejo universitastelogorejo universitastelogorejo.ac.id Prodi S-1 Farmasi dan PSPPA Antimicrobial resistance (AMR) is a condition in which microorganisms ( bacteria, viruses, fungi, or parasites ) are no longer susceptible to the drugs that were previously effective in killing or controlling them Resistance occurs when microorganisms adapt and develop the ability to withstand the effects of antimicrobial agents, such as antibiotics ( including the Post-Antibiotic Effect/PAE ) AMR makes infections more difficult to treat, prolongs the duration of therapy, and increases mortality rates.

7. universitastelogorejo universitastelogorejo universitastelogorejo.ac.id Prodi S-1 Farmasi dan PSPPA Cont ’ The relatively high intensity of antibiotic use has led to various problems and poses a global threat to health, particularly due to bacterial resistance to antibiotics . In addition to its impact on morbidity and mortality , it also carries significant negative economic and social consequences. Initially, resistance emerged at the hospital level, but over time, it has also developed within the community, particularly involving Streptococcus pneumoniae (SP), Staphylococcus aureus , and Escherichia coli

8. universitastelogorejo universitastelogorejo universitastelogorejo.ac.id Prodi S-1 Farmasi dan PSPPA Bacterial Resistence Several antibiotic-resistant pathogens have been widely identified across the globe, including Methicillin-Resistant Staphylococcus aureus (MRSA), Vancomycin-Resistant Enterococci (VRE), Penicillin-Resistant Pneumococci , Klebsiella pneumoniae producing Extended-Spectrum Beta-Lactamase (ESBL), Carbapenem-Resistant Acinetobacter baumannii , and Multidrug-Resistant Mycobacterium tuberculosis . The emergence of these antibiotic-resistant organisms is largely attributed to the irrational use of antibiotics and improper implementation of standard precautions in healthcare facilities

9. universitastelogorejo universitastelogorejo universitastelogorejo.ac.id Prodi S-1 Farmasi dan PSPPA Prevalences The results of the Antimicrobial Resistance in Indonesia (AMRIN-Study) revealed that, among 2,494 individuals from the community, 43% of Escherichia coli were resistant to various antibiotics, including ampicillin (34%), cotrimoxazole (29%), and chloramphenicol (25%). In a study of 781 hospitalized patients, 81% of Escherichia coli were found to be resistant to multiple antibiotics, including ampicillin (73%), cotrimoxazole (56%), chloramphenicol (43%), ciprofloxacin (22%), and entamisin (18%).

10. universitastelogorejo universitastelogorejo universitastelogorejo.ac.id Prodi S-1 Farmasi dan PSPPA No. Gram Negative Bacterial % 1. Pseudomonas spp 22% 2. Acinetobacter spp 22% 3. E coli 16,9% 4. Klebsiella pneumoniae 11,8% 5. Enterobacter aerogenes 10,1% No. Gram Positive Bacterial % 1. Staphylococcus coagulase negative 82,3 2. Staphylococcus aureus 7,2 3. St reptococcus spp 3,9 4. Corynebacterium spp 3,9 5. Enterococcus 2,6 Bacterial Mapping

11. universitastelogorejo universitastelogorejo universitastelogorejo.ac.id Prodi S-1 Farmasi dan PSPPA Escherichia coli Sensitivity Antibiotic % Amikacin 100 Meropenem 88,8 Ceftazidime 88,8 Gentamycine 7 7,7 Cefotaxime 77,7 Imipenem 77,7 Piperacilline tazobactam 77,7 Ampi sulbactam 66,6 Tobramycin 66,6 Ceftriaxone 66,6 Cefoperazone sulbactam 55,5 Amoxyclav 55,5 Ciprofloxacin 55,5 Cotrimoxazole 55,5 Antibiotic % Meropenem 1 00 Amikacin 100 Cefoperazone sulbactam 83,3 Ciprofloxacine 83,3 Levofloxacin 8 3,3 Imipenem 66,6 Cotrimoxazole 66,6 Ampicillin Sulbactam 66,6 Gentamycine 50 Ceftazidim 50 Piperacillin tazobactam 33,3 Cefotaxime 33,3 Amoxyclav 16,7 Ceftriaxone 16,7 Acinetobacter spp sensitivity

12. universitastelogorejo universitastelogorejo universitastelogorejo.ac.id Prodi S-1 Farmasi dan PSPPA Antibiotic % Meropenem 1 00 Amikacin 83,3 Cotrimoxazole 83,3 Gentamycin 50,0 Ceftazidime 50,0 Cefoperazone sulbactam 33,3 Levofloxacin 3 3,3 Imipenem 33,3 Ampicillin Sulbactam 16,7 Piperacillin tazobactam 16,7 Cefotaxime 16,7 Ceftriaxone - Pseudomonas spp . sensitivity

13. universitastelogorejo universitastelogorejo universitastelogorejo.ac.id Prodi S-1 Farmasi dan PSPPA Mechanisms of antibiotic resistance Destroying antibiotics through enzymes produced; Altering the antibiotic receptor binding sites Changing the binding site of the antibiotic receptor Antibiotics are unable to penetrate the cell wall due to changes in the bacterial cell wall properties Antibiotics enter the bacterial cell but are promptly expelled through an active transport mechanism out of the cell

14. universitastelogorejo universitastelogorejo universitastelogorejo.ac.id Prodi S-1 Farmasi dan PSPPA Figure 1 . Molecular Mecanism of Antibiotic Resistance (https:// www.nature.com /articles/s41579-022-00820-y)

15. universitastelogorejo universitastelogorejo universitastelogorejo.ac.id Prodi S-1 Farmasi dan PSPPA Figure 2 . Mecanism of Action of Beta Lactam Lullmann et al. 2005. Color Atlas of Pharmacology 3 rd edition Related with PD Characteristic  TIME DEPENDENT KILLER

16. universitastelogorejo universitastelogorejo universitastelogorejo.ac.id Prodi S-1 Farmasi dan PSPPA Figure 3 . Post Antibiotic Effect Nicolau et al. Antimicrob Agents Chemother 1995;39:650–655 Definition The time required to observe the regrowth of organisms after the administration of antibiotics until the effects of the antibiotics are no longer present the mechanism of antimicrobial categorized into 3: time dependent, conc.dependent , conc dependent-time dependent (combination) Beta Lactam: The duration of the covalent bond interaction between beta-lactam and PBP for the conjugation to occur.

17. universitastelogorejo universitastelogorejo universitastelogorejo.ac.id Prodi S-1 Farmasi dan PSPPA Varghese et al, Antimicrobial Pharmacokinetic and Pharmacodynamic Issues in the Critically Ill with Severe Sepsis and Septic Shock. Crit Care Clin 27 (2011) 19-34

18. universitastelogorejo universitastelogorejo universitastelogorejo.ac.id Prodi S-1 Farmasi dan PSPPA Figure 4 . Pharmacodynamic Approach to Antibiotik Therapy

19. universitastelogorejo universitastelogorejo universitastelogorejo.ac.id Prodi S-1 Farmasi dan PSPPA Principles of Antibiotic Use Prudent antibiotic use  The rational use of antibiotics involves considering the impact of the emergence and spread of resistant bacteria. Antibiotic stewardship programs aim to optimize patient outcomes through coordinated efforts to improve the quality of antibiotic use, encompassing accurate diagnosis, appropriate selection of antibiotic agents, dosing, interval, route, and duration of therapy Antimicrobial stewardship is facilitated by categorizing antibiotics according to the AWARE framework, which comprises Access, Watch, and Reserve categories 

20. universitastelogorejo universitastelogorejo universitastelogorejo.ac.id Prodi S-1 Farmasi dan PSPPA Access This is a narrow-spectrum antibiotic that is generally associated with minimal (or fewer) adverse effects, has a low propensity to select for antimicrobial resistance, and is comparatively inexpensive Bisa dalam bentuk PPK atau PPAB

21. universitastelogorejo universitastelogorejo universitastelogorejo.ac.id Prodi S-1 Farmasi dan PSPPA

22. universitastelogorejo universitastelogorejo universitastelogorejo.ac.id Prodi S-1 Farmasi dan PSPPA Watch This antibiotic class exhibits broader antimicrobial activity and a greater propensity to promote resistance; it is therefore prioritized as a primary target for surveillance and monitoring programs

23. universitastelogorejo universitastelogorejo universitastelogorejo.ac.id Prodi S-1 Farmasi dan PSPPA Reserve This antibiotic class exhibits broader antimicrobial activity and a greater propensity to promote resistance; it is therefore prioritized as a primary target for surveillance and monitoring programs

24. universitastelogorejo universitastelogorejo universitastelogorejo.ac.id Prodi S-1 Farmasi dan PSPPA

25. universitastelogorejo universitastelogorejo universitastelogorejo.ac.id Prodi S-1 Farmasi dan PSPPA The Evaluation of Antibiotic Use in Hospitals Quantitative -> The quantity of antibiotic use refers to the amount of antibiotics used in hospitals, measured both retrospectively and prospectively through validation studies. A validation study is a prospective study conducted to determine the discrepancy between the actual amount of antibiotics used by patients and what is recorded in the medical records. The parameters for calculating antibiotic consumption are: *After calculationg the DDD, then calculate DU 90%

26. universitastelogorejo universitastelogorejo universitastelogorejo.ac.id Prodi S-1 Farmasi dan PSPPA

27. universitastelogorejo universitastelogorejo universitastelogorejo.ac.id Prodi S-1 Farmasi dan PSPPA

28. universitastelogorejo universitastelogorejo universitastelogorejo.ac.id Prodi S-1 Farmasi dan PSPPA The Evaluation of Antibiotic Use in Hospitals Qualitative -> The quality of antibiotic utilization can be evaluated through a comprehensive review of antibiotic prescription records and patient medical charts. This assessment takes into account the appropriateness of diagnosis (clinical manifestations and laboratory findings), indication, dosing regimen, safety profile, and cost-effectiveness. The evaluation framework employs the Gyssens categorization system, which classifies the quality of antibiotic use into distinct categories, including category 0 (appropriate) – category VI (incomplete data)

29. universitastelogorejo universitastelogorejo universitastelogorejo.ac.id Prodi S-1 Farmasi dan PSPPA

30. universitastelogorejo universitastelogorejo universitastelogorejo.ac.id Prodi S-1 Farmasi dan PSPPA Conclusion Injudicious antibiotic use drives antimicrobial resistance , leading to worse clinical outcomes, prolonged length of stay, and increased healthcare costs Antibiotic prescribing should align with WHO’s AWaRe stewardship framework (Access, Watch, Reserve) and relevant national policies to preserve effectiveness Continuous, systematic evaluation of antibiotic use and reported as a quality of care indicator is essential for sustaining stewardship improvements and safeguarding patient health

31. universitastelogorejo universitastelogorejo universitastelogorejo.ac.id Prodi S-1 Farmasi dan PSPPA Thanks for your attention Maraming Salamat Po Terima Kasih