Antibiotic Evaluation Of Hospitalized Pneumonia Patients Using Gyssen or DDD 100 Bed Days or DDD 1000 Patient Days: Systematic Review

Ricky Aditya Syam(1*), Hidayah Karuniawati(2)

(1) Faculty of Pharmacy, University of Muhammadiyah Surakarta, Central Java, Indonesia
(2) Faculty of Pharmacy, University of Muhammadiyah Surakarta, Central Java, Indonesia
(*) Corresponding Author


Pneumonia remains one of the significant infectious diseases in society, especially in developing countries such as Indonesia, with its prevalence continuing to increase year after year. Pneumonia caused by bacteria requires antibiotic treatment, increasing antibiotic use and presenting a risk of antibiotic resistance. Therefore, this study evaluated the use of antibiotics in hospitalized pneumonia patients, with qualitative and quantitative approaches using the Gyssen and ATC / DDD methods. The articles taken as research samples involve a publication period from 2013 to 2023. The data included include the Gyssen parameter, DDD/100, and DDD/1000 patient days. The synthesis showed that ceftriaxone and meropenem antibiotics were the top choices, with values of 1547.735 DDD/100 bed days and 3011.2 DDD/1000 patient days, respectively. Ceftriaxone was documented in 21 journals, while in 8 of 37 journals, meropenem considered antibiotic use in hospitalized pneumonia patients. Evaluation of the quality of antibiotic use showed the highest level in category (0) at 93.7%, followed by (IVa) at 67.6%. Meanwhile, analysis of bacterial resistance to antibiotics showed that Klebsiella pneumonia was the most resistant bacteria, especially to antibiotics carbapenems, ertapenem, doripenem, cephalosporin generation 3, extended-spectrum cephalosporin, and piperacillin/tazobactam, with significant values < 0.05%. These findings provide deep insight into patterns of antibiotic use in hospitalized pneumonia patients while identifying potential areas for improving the quality of antibiotic use and treating bacterial resistance. Thus, this study contributes to efforts to optimize pneumonia management and reduce the impact of antibiotic resistance in the community.


Antibiotics; Defined Daily Dose; Gyssen; Pneumonia.


Ahmad P., Subarnas A. and Muthmainah S.S., 2023, Evaluation Of The Use Of Antibotics In Non-Pneumonia Ari Patients In Two Health Centers In Garut Regency, Scientific Journal of Maritime Pharmaco, 14 (1), 44. Available at:

Alawi M.M., Tashkandi W.A., Basheikh M.A., Warshan F.M., Ghobara H.A., Ramos R.B., Guiriba M.L., Ayob O., Janah S.S., Sindi A.A., Abdulhamid Ahmed S.A., Dammnan S., Azhar E.I., Rabaan A.A., Alnahdi S. and Bamahakesh M.M., 2022, Effectiveness of Antimicrobial Stewardship Program in Long-Term Care: A Five-Year Prospective Single-Center Study Behzadi, P., ed., Interdisciplinary Perspectives on Infectious Diseases, 2022, 1–12. Available at: [Accessed August 31, 2023].

Allel K., Peters A., Conejeros J., Martínez J.R.W., Spencer-Sandino M., Riquelme-Neira R., Rivas L., Rojas P., Orellana Chea C., García P., Araos R., McGovern O., Patel T.S., Arias C.A., Lessa F.C., Undurraga E.A. and Munita J.M., 2023, Antibiotic Consumption During the Coronavirus Disease 2019 Pandemic and Emergence of Carbapenemase-Producing Klebsiella pneumoniae Lineages Among Inpatients in a Chilean Hospital: A Time-Series Study and Phylogenomic Analysis., Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 77 (Suppl 1), S20–S28.

Andarsari M.R., Norachuriya Z., Nabila S.M., Aryani T. and Rosyid A.N., 2022, Assessment of Antibiotic Use in ICU Patients with Pneumonia Using ATC/DDD as a Quantitative Analysis Method, Jurnal Farmasi dan Ilmu Kefarmasian Indonesia, 9 (2), 138–145. Available at: [Accessed August 31, 2023].

Anggraini W., 2021, Qualitative Evaluation Of Antibiotic Use In "X'' Hospital Pneumonia Patients In Malang, KELUWIH: Journal of Health and Medicine, 3 (1), 9–21.

Arifin C. and Roriq A., 2023, Cost Effectiveness of Antibiotic Use for Pneumonia in Indonesian Hospitals, Scientific Journal of Medicamento, 9 (2), 78–89.

Barberi G., De Cola M.C., Dell’Utri D.C., Melardi S., Alagna B., Bramanti P. and Cascio A., 2017, Antimicrobial consumption and antimicrobial resistance: a snapshot of an Italian neuromuscular rehabilitation center.a, The new microbiologica, 40 (2), 119–129.

Barnsteiner S., Baty F., Albrich W.C., Babouee Flury B., Gasser M., Plüss-Suard C., Schlegel M., Kronenberg A. and Kohler P., 2021, Antimicrobial resistance and antibiotic consumption in intensive care units, Switzerland, 2009 to 2018., Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin, 26 (46)

Chrysou K., Zarkotou O., Kalofolia S., Papagiannakopoulou P., Mamali V., Chrysos G., Themeli-Digalaki K., Sypsas N., Tsakris A. and Pournaras S., 2022, Impact of a 4-year antimicrobial stewardship program implemented in a Greek tertiary hospital., European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology, 41 (1), 127–132.

Čižman M., Mioč V., Bajec T., Paragi M., Kastrin T. and Gonçalves J., 2021, Correlation between Antibiotic Consumption and Resistance of Invasive Streptococcus pneumoniae., Antibiotics (Basel, Switzerland), 10 (7)

Desideria P.E., Hasina R., Made N. and Dewi A.R., 2023a, Evaluation Of Antibiotic Use In Inpatients With Ddd (Defined Daily Dose) Method At Unram Hospital In 2021, Available at: [Accessed August 31, 2023].

Desideria P.E., Hasina R., Made N. and Dewi A.R., 2023b, Evaluation Of Antibiotic Use In Inpatients With Ddd (Defined Daily Dose) Method At Unram Hospital In 2021, Available at: [Accessed August 17, 2023].

Dewi A., Sains M.S.-M. and 2023 U., 2023, Evaluation Of Antibiotic Use Of Covid-19 Patients Using Gyssens And Atc/Ddd Methods At Rsau Dr. M. Salamun Bandung City,, 8 (2), 713–722. Available at: [Accessed August 31, 2023].

Ermawati E., Khambri D. and Almasdy D., 2021, The Difference of Using Antibiotics Before and After Antimicrobial Resistance Control Program (PPRA) at RSUP Dr. M. Djamil Padang, Journal Obgin Emas, 5 (1), 29–42. Terdapat di: [Accessed August 31, 2023].

Gutema G., Håkonsen H., Engidawork E. and Toverud E.-L., 2018, Multiple challenges of antibiotic use in a large hospital in Ethiopia - a ward-specific study showing high rates of hospital-acquired infections and ineffective prophylaxis., BMC health services research, 18 (1), 326.

Hurtado I.C., Valencia S., Pinzon E.M., Lesmes M.C., Sanchez M., Rodriguez J., Ochoa B., Shewade H.D., Edwards J.K., Hann K. and Khogali M., 2023, Antibiotic resistance and consumption before and during the COVID-19 pandemic in Valle del Cauca, Colombia., Revista panamericana de salud publica = Pan American journal of public health, 47, e10.

Isnaasar A, Utami H., Science S.K.-P.J. and 2022 undefined, 2022, Evaluation of the Effect of Antibiotic Restriction Policy on the Use of Carbapenem Antibiotics, Available at: [Accessed August 23, 2023].

Izzati U. and Goni N.A., 2022, Evaluation of Antibiotic Use in Surgical Patients at Rspau Dr. S. Hardjolukito Yogyakarta With ATC/DDD System, Pancasakti Journal Of Public Health Science And Research, 1 (3), 149–153. Terdapat di: [Accessed August 31, 2023].

Joseph N.M., Bhanupriya B., Shewade D.G. and Harish B.N., 2015, Relationship between Antimicrobial Consumption and the Incidence of Antimicrobial Resistance in Escherichia coli and Klebsiella pneumoniae Isolates., Journal of clinical and diagnostic research : JCDR, 9 (2), DC08-12.

Karuniawati H., Yulianti T., Aini D.K. and Nurwienda F.I., 2021, Impact of antimicrobial stewardship program on the use of antibiotics in pneumonia patients at teaching hospital in surakarta Indonesia, International Journal of Applied Pharmaceutics, 13 (special issue 1), 20–23. Terdapat di: [Accessed August 31, 2023]..

Kim B., Hwang H., Chae J., Kim Y.S. and Kim D.S., 2023, Analysis of Changes in Antibiotic Use Patterns in Korean Hospitals during the COVID-19 Pandemic, Antibiotics, 12 (2) Terdapat di: [Accessed August 17, 2023].

Kim B., Myung R., Lee M.J., Kim J. and Pai H., 2020, Trend of Antibiotic Usage for Hospitalized Community-acquired Pneumonia Cases in Korea Based on the 2010-2015 National Health Insurance Data., Journal of Korean medical science, 35 (47), e390.

Klein E.Y., Van Boeckel T.P., Martinez E.M., Pant S., Gandra S., Levin S.A., Goossens H. and Laxminarayan R., 2018, Global increase and geographic convergence in antibiotic consumption between 2000 and 2015, Proceedings of the National Academy of Sciences of the United States of America, 115 (15), E3463–E3470.

Kresnawati, V, Herawati F., Crisdiono H. and Yulia R., 2021, Analysis of Antibiotic Use in Community Pneumonia Patients at Kediri District Hospital, MPI (Media Pharmaceutica Indonesiana), 3 (4), 245–252. Available at: [Accessed August 31, 2023].

Kristiani F., Radji M. and Rianti A., 2019, Qualitative Evaluation of Antibiotic Use and Cost Effectiveness Analysis in Paediatric Patients at RSUP Fatmawati Jakarta, Journal of Pharmaceutical & Clinical Science, 6 (1), 46.

Kusuma I.Y., Matuz M., Bordás R., Juhasz Haverinen M., Bahar M.A., Hajdu E., Visnyovszki Á., Ruzsa R., Doró P., Engi Z., Csupor D. and Benko R., 2022, Antibiotic use in elderly patients in ambulatory care: A comparison between Hungary and Sweden, Frontiers in Pharmacology, 13 Terdapat di: [Accessed August 31, 2023].

Limato R., Lazarus G., Dernison P., Mudia M., Alamanda M., Nelwan E.J., Sinto R., Karuniawati A., Rogier van Doorn H. and Hamers R.L., 2022, Optimizing antibiotic use in Indonesia: A systematic review and evidence synthesis to inform opportunities for intervention, The Lancet Regional Health - Southeast Asia, 2 Terdapat di: [Accessed August 31, 2023].

Luciana, Andrajati R., Rianti A. and Khan A.H., 2015, Rational antimicrobial use in an intensive care unit in Jakarta, Indonesia: A hospital-based, cross-sectional study, Tropical Journal of Pharmaceutical Research, 14 (4), 707–714.

Makaba S., Mallongi A. and Author C., 2019, Rationality of Antibiotic Drug Used to Medical Patient Post-Operatively in Selebe Solu Hospital Sorong City Papua Barat Province 2018, International Journal of Science and Healthcare Research, 4 (1), 153–162. Available at: [Accessed August 31, 2023].

Manurung E.R. and Andriani H., 2022, Analysis of the Antimicrobial Stewardship Program Policy on Inpatients Antibiotics Use, Unnes Journal of Public Health, 11 (2), 145–153. Terdapat di: [Accessed August 31, 2023].

Mariana N., Indriyati I., Dinar Widiantari A., Taufik M., Wijaya C., Sarry Hartono T., Oto Wijaya S. and Firmansyah I., 2021, Gambaran Kuantitatif Antibiotik Menggunakan Metode Defined Daily Dose (DDD) Di Ruang Rawat Inap RSPI Prof. Dr. Sulianti Saroso Pada Januari-Juni 2019, Pharmaceutical Journal of Indonesia, 7 (1), 37–42. Available at: [Accessed August 31, 2023].

Mijović G., Čizmović L., Vuković M.N., Stamatović S. and Lopičić M., 2020, Antibiotic Consumption in Hospitals and Resistance Rate of Klebsiella pneumoniae and Escherichia coli in Montenegro., Acta clinica Croatica, 59 (3), 469–479.

Miranda-Novales M.G., Flores-Moreno K., López-Vidal Y., Rodríguez-Álvarez M., Solórzano-Santos F., Soto-Hernández J.L., de León-Rosales S.P., Arredondo-Hernández R., Orduña-Estrada P., Ruiz Ramírez C.G., Baridó-Murguía M.E., Basurto-Chipolini D.A., Reyes-Aguayo M., Castellanos-Martínez J.M., Gil-Veloz M., Rivera-Garay L.R., et al., 2020, Antimicrobial resistance and antibiotic consumption in Mexican hospitals, Salud Publica de Mexico, 62 (1), 42–49.

Mugada V., Mahato V., Andhavaram D. and Vajhala S.M., 2021, Evaluation of Prescribing Patterns of Antibiotics Using Selected Indicators for Antimicrobial Use in Hospitals and the Access, Watch, Reserve (AWaRe) Classification by the World Health Organization., Turkish journal of pharmaceutical sciences, 18 (3), 282–288.

Nelita Manurung P., Permatasari J. and Meirista I., 2022, Evaluation of Antibiotic Use in Pneumonia Patients at Abdul Manap Jambi Regional General Hospital Using the Gyssens Method, Indonesian Impressions Journal, 1 (7), 786–790.

Önal U., Tüzemen Ü., Kazak E., Gençol N., Souleiman E., İmer H., Heper Y., Yılmaz E., Özakın C., Ener B. and Akalin H., 2023, Effects of COVID-19 pandemic on healthcare-associated infections, antibiotic resistance and consumption rates in intensive care units., Le infezioni in medicina, 31 (2), 195–203.

Page M.J., McKenzie J.E., Bossuyt P.M., Boutron I., Hoffmann T.C., Mulrow C.D., Shamseer L., Tetzlaff J.M., Akl E.A., Brennan S.E., Chou R., Glanville J., Grimshaw J.M., Hróbjartsson A., Lalu M.M., Li T., et al., 2021, The PRISMA 2020 statement: An updated guideline for reporting systematic reviews, The BMJ, 372

Pangeran S.A., Manggau M.A. and Djaharuddin I., 2022, Evaluation of the Use of Empirical Antibiotic Therapy on Clinical Outcomes of Inpatient Community Pneumonia Patients, Pharmacy and Pharmacology Magazine, 26 (1), 19–25. Available at: [Accessed August 31, 2023].

Permenkes R.I., 2015, Antimicrobial Resistance Control Program in hospitals. Ministry of Health of the Republic of Indonesia. February 11, 2015., , 8

Popović R., Tomić Z., Tomas A., Anđelić N., Vicković S., Jovanović G., Bukumirić D., Horvat O. and Sabo A., 2020, Five-year surveillance and correlation of antibiotic consumption and resistance of Gram-negative bacteria at an intensive care unit in Serbia, Journal of Chemotherapy, 32 (6), 294–303. Terdapat di: [Accessed August 17, 2023].

Pratama S., Andriani Y. and Habibie M., 2022, Evaluation of Antibiotic Use Based on ATC/DDD and DU 90% Methods at Koni Health Center and Tanjung Pinang Health Center Jambi City for the 2017-2018 Period, Health Information and Promotion, 1 (2), 84–92.

Puspita, D.T. and Dhirisma F., 2021, Evaluation of Antibiotic Use Based on ATC/DDD and DU 90% Methods at Koni Health Center and Tanjung Pinang Health Center Jambi City for the 2017-2018 Period, Health Information and Promotion, 1 (2), 84–92.

Putra D.E., Pramudo S.G., Arkhaesi N. and Retnoningrum D., 2021, Antibiotic Prescribing Patterns During The Covid-19 Pandemic (A Case Study At Diponegoro National Hospital), Medica Hospitalia : Journal of Clinical Medicine, 8 (2), 194–199. Available at: [Accessed August 31, 2023].

Qonita O., Woro L., Suryani D., Made N. and Dewi A.R., 2023, Quantitative Evaluation of Antibiotic Usage in ICU Ward at West Nusa Tenggara Province Hospital in 2018,, 23 (1), 1412–1026. Available at: [Accessed August 31, 2023].

Rachmawati H., Muktamiroh M., Hasmono D., Kusumaningtyas A.P., Yunita S.L. and Yusetyani L., 2023, Antibiotic Use Evaluation in ICU/HCU of Muhammadiyah University General Hospital Malang using DDD and Gyssens Methods, Jurnal Kedokteran Brawijaya, 177–181. Available at: [Accessed August 31, 2023].

Rachmawati S., Fazeri R.L. and Norcahyanti I., 2020, Overview of Antibiotic Use in Internal Medicine Ward of Bangil Hospital, Pasuruan Regency, JPSCR: Journal of Pharmaceutical Science and Clinical Research, 5 (1), 12. Available at: [Accessed August 31, 2023].

Rumende C.M., Chen L.K., Karuniawat A., Bratanata J., Falasiva R., Sitorus T.P. and Susanto E.C., 2019, The Relationship Between the Accuracy of Antibiotic Administration Based on the Gyssens Flow with Clinical Improvement of Patients in Community Pneumonia, Indonesian Journal of Internal Medicine, 6 (2), 71. Available at: [Accessed August 31, 2023].

Sadli N.K., Halimah E., Winarni R. and Widyatmoko L., 2023, The Relationship Between the Accuracy of Antibiotic Administration Based on the Gyssens Flow with Clinical Improvement of Patients in Community Pneumonia, Indonesian Journal of Internal Medicine, 6 (2), 71. Available at: [Accessed August 31, 2023].

Sedláková M.H., Urbánek K., Vojtová V., Suchánková H., Imwensi P. and Kolář M., 2014, Antibiotic consumption and its influence on the resistance in Enterobacteriaceae, BMC Research Notes, 7 (1)

Sitepu R., Cahyono T.T. and Monica E., 2020, Evaluation Of The Use Of Antibiotics With Atc / Ddd And Pdd Methods With Du 90% In Non-Pneumonia Ari Patients At The Sampang District Health Center, Jkft Journal, 5 (1), 16. Available at:

Sitompul F., Radji M. and Bahtiar A., 2016, Evaluation of Antibiotic used with Gyssens Method on Stroke Inpatient at RSUD Koja using Retrospective Approach (K, Indonesian Journal of Pharmacy, 6 (1), 30–38.

Stelzhammer P., Weber W., Binder H., Sagel U., Aspöck C. and Trautinger F., 2022, The bacterial pathogen and resistance spectrum in a dermatological inpatient ward: a six-year, retrospective, epidemiological study., GMS hygiene and infection control, 17, Doc16.

Sukmawati I.G.A.N.D., Adi Jaya M.K. and Swastini D.A., 2020, Evaluation of Antibiotic Use in Inpatient Typhoid Patients at One of the Bali Provincial Government Hospitals with the Gyssens Method and ATC / DDD, Udayana Pharmacy Journal, 37.

Tedeschi S., Trapani F., Giannella M., Cristini F., Tumietto F., Bartoletti M., Liverani A., Pignanelli S., Toni L., Pederzini R., Cavina A. and Viale P., 2017, An Antimicrobial Stewardship Program Based on Systematic Infectious Disease Consultation in a Rehabilitation Facility., Infection control and hospital epidemiology, 38 (1), 76–82.

Vu T.V.D., Do T.T.N., Rydell U., Nilsson L.E., Olson L., Larsson M., Hanberger H., Choisy M., Dao T.T., van Doorn H.R., Nguyen V.K., Nguyen V.T. and Wertheim H.F.L., 2019, Antimicrobial susceptibility testing and antibiotic consumption results from 16 hospitals in Viet Nam: The Vinares project 2012-2013., Journal of global antimicrobial resistance, 18, 269–278.

Van Laethem J., Wuyts S., Van Laere S., Koulalis J., Colman M., Moretti M., Seyler L., De Waele E., Pierard D., Lacor P. and Allard S.D., 2022, Antibiotic prescriptions in the context of suspected bacterial respiratory tract superinfections in the COVID-19 era: a retrospective quantitative analysis of antibiotic consumption and identification of antibiotic prescription drivers., Internal and emergency medicine, 17 (1), 141–151.

WHO, 2013, Guidelines for ATC classification and DDD assignment 2013, Terdapat di:

WHO, 2018, WHO Report on Surveillance of Antibiotic Consumption, Terdapat di:

Widiyastuti A., Kumala S., Utami R H. and Pratama A., 2023, The Relationship of Rationality of Antibiotic Use to Clinical Outcomes of Inpatient Community Pneumonia Patients, Journal of Health, 14 (1), 109. Available at: [Accessed August 31, 2023].

Wojkowska-Mach J., Brudło M., Topolski M., Bochenek T., Jachowicz E., Siewierska M. and Różańska A., 2021, Antibiotic consumption in long-term care facilities in Poland and other European countries in 2017., Antimicrobial resistance and infection control, 10 (1), 154.

Yulia R., Yuaraningtiyas G. and Wiyono H., 2017, Profile of Antibiotic Use and Germ Map in the Inpatient Room of Husada Utama Hospital Surabaya, National Meeting and Annual Scientific Meeting of the Indonesian Pharmacists Association 2017, (ISNN: 2541-0474), 228-237. Available at: [Accessed August 31, 2023].

Ziółkowski G., Pawłowska I., Krawczyk L. and Wojkowska-Mach J., 2018, Antibiotic consumption versus the prevalence of multidrug-resistant Acinetobacter baumannii and Clostridium difficile infections at an ICU from 2014–2015, Journal of Infection and Public Health, 11 (5), 626–630. Available at: [Accessed August 17, 2023].

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