Tugas Ebm Kel 9

EVIDENCE BASED LEARNING
Oleh: Pembimbing:
Maulia Sari Khairunnisa 04011181419016
dr. Achmad Ridwan, MO, M.Sc
Vondy Holianto 04084821820014
Essy Avida Tholibiyah 04084821820020
M. Rifki Al Ikhsan 04054821820055
BAGIAN ILMU KESEHATAN MASYARAKAT

ILMU KEDOKTERAN KOMUNITAS
FAKULTAS KEDOKTERAN
UNIVERSITAS SRIWIJAYA
2019
Scenario
 9-years-old child has fever and abdominal pain. Laboratory finding
shows Tubex (+6). Doctor considers giving antibotic ciprofloxacin or
ceftriaxone to get faster improvement.
Clinical Problem
PICO
 P Population
Children
 I Intervention
Using antibiotic ceftriaxone
 C Comparison
Using antibiotic ciprofloxacin
 O Outcome
Effective therapy for typhoid fever (get faster improvement)
Answerable Question
 Which is the most effective using ciprofloxacin or ceftriaxone in typhoid
fever treatment?
Search Key
 “Typhoid fever treatment” AND “Efficacy” AND “Ciprofloxacin” AND
“Ceftriaxone”
Critical Appraisal
Validity
F: Patient Follow-Up
Were all patients who entered the trial properly accounted for at its conclusion?
Losses to follow-up should be less than 20% and reasons for drop-out given.
Answer:
Yes, all patients who entered the trial properly accounted for at its conclusion.
Critical Appraisal
Validity
R: Randomization
 Were the recruited patients representative of the target population?
Answer:
Yes, the recruited patients are representative of target population. Children 5-12
years old of both sexes those having typhoid fever admitted in the pediatric ward
of Holy Family Hospital were included in the study.
Critical Appraisal
Validity
R: Randomization
 Was the allocation (assignment) of patients to treatment randomized and
concealed?
Answer:
Yes, it was randomized and concealed. The samples were randomly divided into
two groups, A and B. Group A was given Inj.Ciprofloxacin 10mg/kg I/V twice daily,
while group B was given Inj. Ceftriaxone 70mg/kg I/V once daily for 7 days.
Critical Appraisal
Validity
I: Intention to Threat Analysis
 Were patients analyzed in the groups to which they were randomized?
Answer:
 Yes, patients analyzed in the groups to which they were randomized.
Critical Appraisal
Validity
I: Intention to Threat Analysis
 Were all randomized patient data analyzed? If not, was a sensitivity of “worst
case scenario” analysis done?
Answer:
 Yes, all randomized patient data was analyzed.
Critical Appraisal
Validity
B: Blinding
Were patients, health workers, and study personnel “blind” to treatment?
Answer:
In this trial, the subjects are blinded about the drugs that given by the doctor
(single blinding).
Critical Appraisal
Validity
E: Equal Treatment
Aside from the experimental intervention, were the groups treated equally?
Answer:
Yes, except for the experimental intervention, the subjects in both groups were
treated equally.
Critical Appraisal
Validity
Summary
This study is valid, except the blinding.
Critical Appraisal
Importancy
Typhoid fever
(Still febrile in 96 hours after
treatment) Total
Yes No
Ceftriaxone 1 43 44
Ciprofloxacin 19 25 44
Critical Appraisal
Importancy
Importancy
CER 0,43
(The incidence of typhoid fever in control group after 96 hours of treatment
as 0,43).
EER 0,02
(The incidence of typhoid fever in experiment group after 96 hours of
treatment as 0,02)
RRR 0,94
(Ceftriaxone can decrease the incidence of typhoid fever after 96 hours of
treatment as high as 94%).
ARR 0,40
(The difference in the incidence of typhoid fever after 96 hours of
treatment in patient given ceftriaxone vs ciprofloxacin as 40%)
Critical Appraisal
Importancy
Importancy
NNT 2,44
(2,44 patient need to be given ceftriaxone to prevent 1 patient from typhoid
fever after 96 hours of treatment).
Summary This study is clinicaly important (RRR is more than 30%).
Critical Appraisal
Applicability
Applicability
Will the result help me in caring for my patient? (External validity/ Applicability)
Is my patient so different to those in the study that No

the results cannot apply?
Is the treatment feasible in my setting? Yes
Will the potential benefits of treatment outweigh Yes
the potential harms of treatment for my patient?
Summary This study is
applicability.
Conclusion
 This study is valid, important, and applicability.
TERIMA KASIH

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EVIDENCE BASED LEARNING

BAGIAN ILMU KESEHATAN MASYARAKAT

Is my patient so different to those in the study that No

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