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"This book describes antibiotic resistance amongst pathogenic bacteria. It starts with an overview of the erosion of the efficacy of antibiotics by resistance and the decrease in the rate of replacement of redundant compounds. The origins of antibiotic resistance are then described. It is proposed that there is a large bacterial resistome which is a collection of all resistance genes and their precursors in both pathogenic and non-pathogenic bacteria. Ongoing resistance surveillance programs are also discussed, together with the perspective of a clinical microbiologist. The book then turns to specific themes such as the most serious area of resistance in pathogens, namely in Gram-negative organisms. The role of combinations of antibiotics in combating resistance emergence is discussed, particularly in the tuberculosis field, and then the importance of non-multiplying and persistent bacteria which are phenotypically resistant to antibiotics and prolong the duration of therapy of antibiotics which leads to poor compliance and resistance emergence. The role of anti-microbial compounds in textiles is covered, with its potential to exacerbate the spread of resistance. Then, efflux pumps are discussed. The final chapter describes the compounds which are in late stage clinical development, illustrating the paucity of the antibiotic pipeline, especially for Gram-negative bacteria."

"This book, which is the translated version of a Swedish book, combines a general introduction of a variety of antibiotics with a more in-depth discussion of resistance. The focus on resistance in learning about antibiotics will help future scientists recognize the problem antibiotics resistance poses for medicinal and drug-related fields, and perhaps trigger more research and discoveries to fight antibiotic resistant strains. Current overviews of the topic are included, along with specific discussions on the individual mechanisms (betalactams, glycopeptides, aminoglycosides, etc) used in various antibacterial agents and explanations of how resistances to those develop. Methods for counteracting resistance development in bacteria are discussed as well."

"Seven antibiotics including norfloxacin (NOR) were tested via disk susceptibility test on E. coliculture isolated from the MLSS of the two types of lab-scale sequencing batch reactors (SBR), acommon SBR and an SBR with rnicrofiltration membrane (SB-MBR) for treatment of syntheticmunicipal wastewater. The same experiment treating the NOR-added wastewater to examine thepossible induction of resistance to itself and the other antibiotics. The MLSS from Banglculture (TISTR780) were spiked daily into both reactors. The reactors were continuously operatedunder 2hr/2hr of aeration/non-aeration cycle and resistances to antibiotics of E. coli in MLSS weremonitored. When NOR was not added, the SB-MBR showed lower percentages of resistant E. colithan the SBR did to amoxicillin/clavulanic acid, amikacin, nalidixic acid, tetracycline andchloramphenicol. Oppositely, the SB-MBR treating the NOR-added wastewater appeared topromote resistances of E. coli to nalidixic acid, sulfamethoxasole and tetracycline probably due to along SRT and low DO compared to that of SBR. Although its mechanism should be analyzed withmolecular techniques in further studies, this NOR-induced expression of resistance resulted in ahigher occurrence of multidrug resistant E. coli in the SB-MBR than that in the SBR."

"Resistensi antibiotik merupakan masalah global yang semakin meningkat dan menjadi ancaman serius bagi kesehatan manusia. Untuk mengatasi masalah resistensi antibiotik, perlu dilakukan upaya pencegahan dan pengendalian yang melibatkan berbagai pihak, termasuk apoteker sebagai tenaga kesehatan yang berperan penting dalam penggunaan antibiotik yang tepat dan rasional. Tugas khusus ini bertujuan memberi pengetahuan kepada masyarakat melalui pemberian informasi antibiotik secara tepat dan menanggulangi resistensi antibiotik dengan menggunakan media poster. Metode penelitian yang digunakan adalah observasi terhadap respons dan pemahaman masyarakat terhadap poster yang berisi informasi tentang resistensi antibiotik di Puskesmas Kecamatan Cengkareng, Jakarta barat. Hasil tugas khusus ini menunjukkan bahwa penggunaan poster oleh apoteker efektif dalam meningkatkan pemahaman masyarakat mengenai dampak resistensi antibiotik dan pentingnya penggunaan antibiotik yang rasional. Implikasi dari penelitian ini adalah pentingnya peran aktif apoteker dalam mendidik masyarakat melalui media visual seperti poster untuk mengurangi risiko resistensi antibiotik dalam komunitas.

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Self-medication is an attempt by people to treat themselves. Passive provision of information is carried out through making price tags on solid preparations of medicine for diarrhea and constipation, while active information is carried out through self-medication services to patients. The aim of this special task is to provide drug information on the solid dosage price tags of the I1 drug department as many as 21 sku as a passive form of information and to provide active information through self-medication to patients. The special task method used is placing price tags and carrying out self-medication on Roxy Poltangan Pharmacy patients who need medication for diarrhea and constipation. The results of this special assignment show that the process of creating product information is carried out by considering legal aspects, safety and clinical information that are relevant to consumers. Factors such as patient needs also influence the content of the information displayed. The implication of this research is to increase the transparency of product information in pharmacies, so that consumers can make more informed decisions regarding the use of self-medication for diarrhea and constipation."

"Disertasi ini menghasilkan temuan bahwa clinical pathway yang disusun oleh berbagai profesi sesuai kompetensi, peran, tugas, dan tanggung jawab masing-masing profesi dalam perawatan pasien dapat digunakan sebagai media komunikasi, bekerja sama, berkoordinasi dalam praktek kolaborasi interprofesional. Praktek kolaborasi interprofesional dengan menggunakan clinical pathway dapat mengoptimalkan penggunaan antibiotik untuk mencegah terjadinya resistensi bakteri. Penelitian ini adalah kombinasi penelitian kuantitatif dan kualitatif dengan desain deskriptif analitik. Hasil penelitian menyarankan bahwa penyusunan clinical pathway tidak hanya berbasis bukti tetapi juga merupakan kesepakatan perawatan bersama oleh beberapa profesi tenaga kesehatan untuk meningkatkan kualitas pelayanan, terutama penggunaan antibiotik rasional.

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The finding of this dissertation is clinical pathways prepared by various professions according to the competencies, roles, values, and responsibilities of each profession in patient care. A clinical pathway is a tool for communication, working together, and coordination in interprofessional collaborative practices. Interprofessional collaboration practices using clinical pathways can optimize the use of antibiotics to prevent bacterial resistance. This research is quantitative and qualitative research that analyzes analytics descriptively. The study suggests that the development of a clinical pathway is not only evidence based practice but also a joint agreement by several healthcare professionals to improve the quality of services, especially the rational use of antibiotics."

"Gen resistensi antibiotik (ARGs) dapat ditransfer antar bakteri melalui elemen genetik bergerak (MGEs) dengan transfer gen horizontal (HGT), yang berkontribusi signifikan terhadap penyebaran bakteri yang resisten terhadap berbagai obat di lingkungan. Air limbah yang tidak terolah, terutama di daerah dengan sanitasi yang kurang memadai, berfungsi sebagai reservoir bagi resistensi antibiotik. Namun, penelitian mengenai konsentrasi ARGs pada air limbah tidak terolah masih terbatas. Penelitian ini berfokus pada keberadaan ARGs dalam air limbah tidak terolah yang berasal dari air drainase pada pemukiman di DKI Jakarta dan mengkaji hubungan antara logam berat, MGEs, dan kelimpahan ARGs. Metode pengujian yang digunakan adalah High- Throughput qPCR untuk menguji ARGs dan Spektrometri UV-Vis DR 2000 untuk logam berat. Hasil penelitian menunjukkan bahwa MGEs dan ARGs, khususnya gen intl3 dan aadA2_3, sangat melimpah dalam air limbah tidak terolah. Tidak terdapatnya perbedaan konsentrasi ARGs pada air drainase yang berasal dari kelompok menengah atas dan menengah dapat terjadi akibat sampel yang kurang representatif. Uji korelasi Spearman menunjukkan adanya korelasi cukup positif yang signifikan secara statistik antara kadar logam mangan dan seng dengan MGEs dan beberapa ARGs, serta korelasi yang sangat kuat antara MGEs dan semua ARGs. Temuan ini mendukung adanya hubungan antara logam berat, MGEs, dan kelimpahan ARGs.

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Antibiotic resistance genes (ARGs) can be transferred between bacteria through mobile genetic elements (MGEs) via horizontal gene transfer (HGT), significantly contributing to the spread of bacteria resistant to various drugs in the environment. Untreated wastewater, especially in areas with inadequate sanitation, serves as a reservoir for antibiotic resistance. However, research on ARG concentrations in untreated wastewater is still limited. This study focuses on the presence of ARGs in untreated wastewater from drainage in residential areas of Jakarta and examines the relationship between heavy metals, MGEs, and ARG abundance. Testing methods used were High- Throughput qPCR for ARGs and UV-Vis DR 2000 Spectrometry for heavy metals. The research results indicate that MGEs and ARGs, particularly the intl3 and aadA2_3 genes, are highly abundant in untreated wastewater. The lack of difference in ARG concentrations in drainage water from upper-middle and middle-class groups may be due to non-representative sampling. Spearman correlation tests show a statistically significant positive correlation between manganese and zinc levels with MGEs and some ARGs, as well as a very strong correlation between MGEs and all ARGs. These findings support the relationship between heavy metals, MGEs, and ARG abundance."

"Pemakaian antibiotika tidak rasional menyebabkan resistensi antibiotika. Implementasi kebijakan penggunaan antibiotika di RSUP Sanglah Denpasar belum pernah di evaluasi. Tujuan penelitian ini mengetahui implementasi kebijakan penggunaan antibiotika, mencegah resistensi antibiotika dan mengetahui penerapan intervensi WHO untuk peningkatan penggunaan obat rasional. Penelitian ini merupakan penelitian deskriptif kualitatif, dengan melakukan wawancara dan penelusuran dokumen. Analisa data dengan content analysis. Hasil penelitian menunjukkan implementasi kebijakan penggunaan antibiotika dan penerapan intervensi WHO belum berjalan baik. Pencegahan resistensi antibiotika belum terkoordinir baik dari empat pilar Tim Program Pengendalian Resistensi Antimikroba. Diperlukan revisi dan sosialisasi pelaksanaan kebijakan pengguna anantibiotika, juga pencegahan dan pengendalian infeksi.

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Irrational use of antibiotics lead to antibiotic resistance. Implementation of the policy on the use of antibiotics in Sanglah Hospital in Denpasar has never been evaluated. The purpose of this study to know the implementation of policy on the use of antibiotics, preventing antibiotic resistance and determine the application ofthe WHO interventions to improve rational drug use. This research is aqualitative descriptive study, with interviews and document searches. Data analysis with content analysis.

The results showed the use of antibiotics policy implementation and application of WHO intervention has not gone well. Prevention of antibiotic resistance have not been well coordinated team of four pillars of Antimicrobial Resistance Control Program. Required revision and dissemination of antibiotic usage policy enforcement, as well as prevention and control of infection."

"Kejadian resistensi antibiotik meningkat di seluruh dunia. Unit pengolahan limbah rumah sakit dapat menjadi sumber penularan serta tempat berkembang biak maupun munculnya bakteri resisten antibiotik. Penelitian ini dilakukan untuk mengetahui jumlah bakteri resisten antibiotik yang direpresentasikan dengan Escherichia coli (E. coli) pada influen dan effluen unit pengolahan limbah rumah sakit IPAL Terpadu 2 RSUPN Dr. Cipto Mangunkusumo (RSCM). Sebagian besar air limbah terdiri dari buangan feses dan urin pasien rawat inap di Gedung A RSCM. Antibiotika yang diuji untuk resistensi adalah Meropenem, Cefixime, dan Ciprofloxacin melalui metode disk diffusion test. Hasil yang didapatkan menunjukkan E. coli resistensi terhadap Ciprofloxacin, Cefixime, dan Meropenem masing-masing sebesar 50,96%, 47,63%, dan 14,18%. Efisiensi terbesar dalam mengurangi jumlah mikroorganisme pada unit pengolahan di IPAL Terpadu 2 RSCM adalah pada unit disinfeksi, yaitu sebesar 97,14%.

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The incidence of antibiotic resistance is increasing worldwide. Hospital wastewater treatment plant can become a source for transmission as well as place for breeding and development of antibiotic resistance bacteria. The study was conducted to determine the number of antibiotic-resistant bacteria that is represented by Escherichia coli (E. coli) in the influent and effluent hospital wastewater treatment plant in Wastewater Treatment Plant 2 of RSUPN Dr. Cipto Mangunkusumo. The wastewater mostly consisted of faeces and urine from hospitalized patients in Building A RSCM. The antibiotics to be tested for resistance are Meropenem, Cefixime, and Ciprofloxacin using disk diffusion test method. The results showed E. coli resistance to Ciprofloxacin, Cefixime, and Meropenem are respectively 50,96%, 47,63%, and 14,18%. The highest eficiency in decreasing the number of microorganism in IPAL Terpadu 2 RSCM is achieved by the disinfection unit, that is 97,14%."

"ABSTRAKFaktor yang berhubungan dengan pasien berkontribusi terhadap meningkatnya prevalensi resistensi antibiotik. Hal tersebut menuntut dilakukan suatu upaya peringatan akan bahaya resistensi antibiotik. Penelitian ini bertujuan untuk menganalisis faktor-faktor yang berpengaruh terhadap respon penerimaan pesan gambar peringatan bahaya resistensi antibiotik yang dikembangkan dari Extended Parallel Process Model EPPM . 3 buah gambar peringatan yang berisi tentang resistensi antibiotik dapat menyebabkan kematian, makin lamanya penyembuhan luka operasi, dan hari perawatan di rumah sakit yang bertambah lama dipilih untuk diteliti, dan dengan desain potong lintang yang digunakan untuk melihat pengaruh faktor usia, jenis kelamin, pendidikan dan pekerjaan terhadap respon penerimaan pesan dari ketiga gambar tersebut pada 402 orang responden. Hasil yang diperoleh adalah ketiga gambar tersebut menghasilkan komponen ancaman yang tinggi dan komponen efikasi yang tinggi pula. Respon penerimaan pesan yang dihasilkan adalah baik, sehingga dianggap efektif menyampaikan informasi mengenai bahaya resistensi antibiotik kepada masyarakat. Gambar peringatan mengenai bahaya resistensi antibiotik dapat mengakibatkan makin lamanya penyembuhan luka operasi menjadi gambar yang paling efektif dibanding gambar peringatan lainnya. Faktor yang meningkatkan respon penerimaan pesan yang baik mengenai bahaya resistensi antibiotik adalah kelompok usia dewasa awal, jenis kelamin perempuan, pendidikan tinggi dan yang tidak bekerja.

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ABSTRACTPatient related factors contribute to the increased prevalence of antibiotic resistance. It requires an attempt to warn of the dangers of antibiotic resistance. This study aims to analyze the factors that influence the response of receiving the antibiotic resistance warning picture message developed from the Extended Parallel Process Model EPPM . 3 warning images containing antibiotic resistance can cause death, increasing length of wound healing, and lengthy hospitalization days selected for study, and with cross sectional design used to examine the effect of age, sex, education and work on the response of receiving messages from these three images on 402 respondents. The results obtained are the three images produce high threat components and high efficacy components as well. The response of received messages generated is good, so it is considered effective to convey information about the danger of antibiotic resistance to the community. A warning picture of the dangers of antibiotic resistance may result in the longer duration of surgical wound healing being the most effective image than any other warning image. Factors that improve the response of good messages about the dangers of antibiotic resistance are the early adult age group, female gender, college education and non working."