Evaluation of Antibiotic Utilization in Respiratory Tract Infections Using ATC/DDD and Gyssens Methods
Downloads
Respiratory tract infections affect both the upper and lower respiratory tract and remain a major global health problem, with pneumonia prevalence reaching around 23% across all age groups. The high incidence often leads to increased antibiotic use, which may contribute to antimicrobial resistance if used inappropriately. Therefore, antimicrobial stewardship (AMS) programs are essential to monitor and optimize antibiotic use in hospitals. This study aimed to analyze antibiotic utilization in patients with respiratory tract infections using the Anatomical Therapeutic Chemical/Defined Daily Dose (ATC/DDD) method and the Gyssens method at Dr. Soedarso Regional General Hospital, Pontianak. A prospective observational study was conducted using medical record data of 248 inpatients aged ?18 years who received antibiotic therapy during January–December 2023. The results showed that most patients were male (62.9%). Quantitative analysis indicated that Ceftriaxone and Levofloxacin were the most frequently used antibiotics based on DDD/100 patient-days. Qualitative evaluation using the Gyssens method revealed that most antibiotic use was appropriate, although some cases still showed inappropriate indications, duration, alternative therapy selection, and timing of administration.
Andarsari MA, Norachuriya Z, Nabila SM, Aryani T, Rosyid AN. Assessment of antibiotic use in ICU patients with pneumonia using ATC/DDD as a quantitative analysis method. J Farm Ilmu Kefarm Indones. 2022;9(2):138-145. doi:10.20473/jfiki.v9i22022.138-145.
Aviatin M, Sauriasari R, Yunir E, Risni HW. Evaluation of the use of antimicrobial therapy for treating diabetic foot infections in an Indonesia referral hospital: a retrospective cohort study. Infect Chemother. 2023;55(1):80-89. doi:10.3947/ic.2022.0084.
Barlam TF, Cosgrove SE, Abbo LM, et al. Implementing an antibiotic stewardship program: guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Clin Infect Dis. 2016;62(10):e51-e77. doi:10.1093/cid/ciw118.
Bertagnolio S, Dobreva Z, Centner CM, et al. WHO global research priorities for antimicrobial resistance in human health. Lancet Microbe. 2024;5(11):100902. doi:10.1016/S2666-5247(24)00134-4.
Bradley JS, Byington CL, Shah SS, et al. The management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines. Clin Infect Dis. 2011;53(7):e25-e76.
Cantón R, Horcajada JP, Oliver A, Ruiz-Garbajosa P, Vila J. Inappropriate use of antibiotics in hospitals: the complex relationship between antibiotic use and antimicrobial resistance. Enferm Infecc Microbiol Clin. 2013;31(Suppl 4):3-11.
Cioboata R, Balteanu MA, Osman A, et al. Coinfections in tuberculosis in low- and middle-income countries: epidemiology, clinical implications, diagnostic challenges, and management strategies. J Clin Med. 2025;14(7):2154. doi:10.3390/jcm14072154.
Cusini A, Rampini SK, Bansal V, Ledergerber B, Kuster SP, Ruef C, et al. Different patterns of inappropriate antimicrobial use in surgical and medical units at a tertiary care hospital. PLoS One. 2010;5(11):e14011.
Davey P, Marwick CA, Scott CL, Charani E, McNeil K, Brown E, et al. Interventions to improve antibiotic prescribing practices for hospital inpatients. Cochrane Database Syst Rev. 2017;(2):CD003543.
Fadrian A, Aliska G, Utami WN. The relationship between appropriateness of antibiotic use based on the Gyssens algorithm and mortality: a retrospective cohort study in an Indonesian tertiary hospital. Acta Med Indones. 2024;56(2):137-144.
Fajriansyah, Awaluddin A, Welly, Zulfahmidah. Monitoring the use of antibiotics in children patients acute respiratory infection using ATC/DDD method. J Penelit Pendidik IPA. 2023;9(12):11066-11071. doi:10.29303/jppipa.v9i12.6280.
Gyssens IC. Quality measures of antimicrobial drug use. Int J Antimicrob Agents. 2001;17(4):9-19.
Gyssens IC, et al. Optimizing antimicrobial therapy: a method for antimicrobial drug use evaluation. J Antimicrob Chemother. 2008;41(3):315-322.
Hardiana I, Laksmitawati DR, Ramadaniati HU. Evaluasi penggunaan antibiotika pada pasien pneumonia komunitas di instalasi rawat inap RSPAD Gatot Subroto. Maj Farm Farmakol. 2021;25(1):1-6.
Hasan H, Katu S, Halim R. Evaluation of the compatibility of antibiotic use with the Gyssens plot in community-acquired pneumonia patients. Antimicrob Steward Healthc Epidemiol. 2025;5(Suppl 1):S17. doi:10.1017/ash.2025.125.
Kandimahforoujaki S, et al. A systematic scoping review of metrics utilized to measure antibiotic consumption in hospital settings. Br J Clin Pharmacol. 2025.
Lai CC, Chen SY, Ko WC, Hsueh PR. Increased antimicrobial resistance during the COVID-19 pandemic. Int J Antimicrob Agents. 2021;57:106324..
Lee SH. Tuberculosis infection and latent tuberculosis. Tuberc Respir Dis (Seoul). 2016;79:201-206.
Natsch S, Hekster YA, de Jong R, Heerdink ER, Herings RMC, van der Meer JWM. Application of the ATC/DDD methodology to monitor antibiotic drug use. Eur J Clin Microbiol Infect Dis. 1998;17:20-24. doi:10.1007/BF01584358.
Pauwels I, Versporten A, Drapier N, Vlieghe E, Goossens H. Hospital antibiotic prescribing patterns according to the WHO AWaRe classification. J Antimicrob Chemother. 2021;76(6):1614-1624. doi:10.1093/jac/dkab050..
Puspitasari CE. Analisis penggunaan antibiotika pada pasien infeksi saluran kemih secara kuantitatif di RSUD Provinsi NTB tahun 2019. Pharm J Indones. 2024;9(2).
Richards DM. Ceftriaxone: a review of its antibacterial activity, pharmacological properties and therapeutic use. Drugs. 1985;29(Suppl 2):1-60.
Sitompul PA, Indriani R, Rusli A, Sundari T, Rosamarlina R, Hartono TS, et al. Antimicrobial sensitivity pattern from hospitalized pneumonia patients in Indonesia. Adv Med. 2022:3455948.
Syam R, Karuniawati H. Antibiotic evaluation of hospitalized pneumonia patients using Gyssens or DDD 100 bed days or DDD 1000 patient days: a review. Pharmacon J Farm Indones. 2024;21(Special Issue 1):49-64. doi:10.23917/pharmacon.v21i0.23589.
Copyright (c) 2026 Samirah Samirah, Maria Oktavia, Noer Qonita, Risa F Musawaris, Mareta Rindang

This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution-ShareAlike 4.0 International. that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.








