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FORM EVALUASI KUALITAS PENGGUNAAN ANTIBIOTIK

(Gyssens et al flowchart)

No Nama antibiotik Rejimen Rute Tipe terapi Indikasi Tgl Tgl Kategori(Gyssens) KETERANGAN
Kode Dosis (P/E/EE/D) mulai stop VI V IV III A III B II I 0
pasien (A,B,C,D) (A,B,C)

Keterangan Tipe Terapi :


P = Antibiotik Profilaksis
E = Antibiotik Empiris
EE = Antibiotik Extended Empiris
D = Antibiotik Definitif

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