Melakukan De-eskalasi Antibiotik di Rumah Sakit

Oleh :

dr.Catharina Endah Wulandari, M.Si.Med

De-eskalasi antibiotik adalah strategi untuk mempersempit spektrum aktivitas regimen antibiotik dengan cara mengubah ataupun menghentikan komponen regimen tertentu. Dengan adanya de-eskalasi, efikasi pemberian antibiotik diharapkan lebih optimal dan angka resistensi antibiotik diharapkan turun.[1-3]

Resistensi antibiotik merupakan masalah serius yang berkaitan dengan peningkatan morbiditas dan mortalitas pasien. Hal ini terutama disebabkan oleh peresepan antibiotik yang tidak sesuai indikasi dan penggunaan antibiotik berspektrum luas. Antimicrobial Stewardship Program (ASP) sangat penting untuk menjaga efikasi antibiotik sekaligus memastikan outcome pasien optimal. Pedoman internasional menyarankan de-eskalasi antibiotik sebagai bagian dari ASP.[1-3]

Definisi De-eskalasi Antibiotik

(Konten ini khusus untuk dokter. Registrasi untuk baca selengkapnya)

Referensi

1. GBD 2021 Antimicrobial Resistance Collaborators. Global burden of bacterial antimicrobial resistance 1990-2021: a systematic analysis with forecasts to 2050. Lancet. 2024;404(10459):1199-1226. doi:10.1016/S0140-6736(24)01867-1
2. Hart C, Biehle L, Jeffres M. When Should We De-Escalate Empiric Antimicrobials? Contagion Spring Digital Edition. 2025;10(1).
3. Matuszak SS, Kolodziej L, Micek S, Kollef M. Antibiotic De-Escalation in the Intensive Care Unit: Rationale and Potential Strategies. Antibiotics. 2025;14(467). https://doi.org/10.3390/ antibiotics14050467
4. Moehring R, Ashley E, Davis A, Dyer A, Parish A, et al. Development of an Electronic Definition for De-escalation of Antibiotics in Hospitalized Patients. Clinical Infectious Diseases. 2021;73(11):e4507–14
5. Gupta A, Heath M, Walzl E, Ratz D, Munroe E, et al. Antibiotic De-Escalation in Adults Hospitalized for Community-Onset Sepsis. JAMA Intern Med. 2025. doi:10.1001/jamainternmed.2025.6919
6. Viasus D, Abelenda G, Bolivar-Areiza J, Gudiol C, Carratalà J. Effects of Antibiotic De-Escalation on Outcomes in Severe Community-Acquired Pneumonia: An Inverse Propensity Score-Weighted Analysis. Antibiotics. 2025. https://doi.org/10.3390/antibiotics14070716
7. Alshareef H, Alfahad W, Albaadaani A, Alyazid B, Ruba Bin Talib. Impact of antibiotic de-escalation on hospitalized patients with urinary tract infections: A retrospective cohort single center study. Journal of Infection and Public Health. 2020.
8. Alanazi A, Almuhaya R, Almohaimeed M, Alahmari N, Abdulrahim N, et al. Impact of Antibiotic De-Escalation on Antibiotic Consumption, Length of Hospitalization, Mortality, and Cost: A Systematic Review and Meta-Analysis. Pharmacoepidemiology. 2023.
9. Abu-Farha RK, Gharaibeh L, Alkhawaldeh R, Abu Hammour K, Binsaleh AY, Shilbayeh SA, Al-Ashwal FY. Escherichia coli and MSSA urinary tract infections: Carbapenem de-escalation challenges and outcomes. Electron J Gen Med. 2025;22(6):em698. https://doi.org/10.29333/ejgm/17392
10. Anil A, Ann A, Wilson S, Thomas T, James E, Kumar A. De-Escalation of Antibiotic in Respiratory Infections. Indian Journal of Pharmacy Practice. 2025;19(2):1-8.
11. Tabah A, Bassetti M, Kollef M, Zahar J, Paiva J, et al. Antimicrobial de-escalation in critically ill patients: a position statement from a task force of the European Society of Intensive Care Medicine (ESICM) and European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Critically Ill Patients Study Group (ESGCIP). Intensive Care Med. 2020;46:245–265. https://doi.org/10.1007/s00134-019-05866-w
12. Kementerian Kesehatan Indonesia. Pedoman Nasional Pelayanan Kedokteran Tata Laksana Pneumonia pada Dewasa. Keputusan Menteri Kesehatan Republik Indonesia, 2023. Hk.01.07/Menkes/2147/2023