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Antibacterial Activity from Temulawak Extract (Curcuma xanthorrhiza Roxb) on Growth Inhibition of Staphylococcus epidermidis In Vitro Ni Wayan Mutiara Warmasari; Desak Ketut Ernawati; Agung Wiwiek Indrayani; Ni Wayan Sucindra Dewi; I Made Jawi
Jurnal Epidemiologi Kesehatan Komunitas Vol 5, No 1: Februari 2020
Publisher : Master of Epidemiology, School of Postgraduate Studies, Diponegoro University, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (303.357 KB) | DOI: 10.14710/jekk.v5i1.6909

Abstract

Background: Infection is one of the main causes of disease in tropical regions like Indonesia. One of them can be caused by bacterial infection of Staphylococcus epidermidis. Staphylococcus epidermidis is an opportunistic bacterium that attacks individuals when the body's immune system is weak. The incidence of bacterial resistance to antibiotics that already exist so that requires an alternative treatment, one of which is the use of temulawak rhizome extract (Curcuma xanthorrhiza Roxb). Temulawak rhizome is one of the spices which is still often used as traditional medicine among Indonesian people. Temulawak rhizome extract is known to have a variety of chemical contents with active compounds in the form of essential oils xanthorrhizol and curcumin which can affect the rate of bacterial growth.Methods: This study aims to determine the antibacterial activity of temulawak rhizome extract on the growth of Staphylococcus epidermidis bacteria in vitro. The method used in this study is the true experimental post test only control group design. Samples were divided into four treatment concentrations such as the extract concentration of 25%, 50%, 75%, and 100% of temulawak rhizome which was tested by agar diffusion method (Kirby-Bauer).Result: The results of the analyze of variant (ANOVA) test showed a significant difference (p = 0,000). The temulawak extract could inhibit bacterial growth with a medium inhibitory response (5-10 mm). Temulawak rhizome extract showed the greatest inhibition at 100% concentration with an average inhibition zone diameter of 9.20 mm.Conclusion : The extract of temulawak rhizome has antibacterial activity. The higher concentration of temulawak rhizome extract (Curcuma xanthorrhiza Roxb), the greater ability to inhibit the growth of Staphylococcus epidermidis bacteria. 
Protective Effect of Lemon (Citrus limon L.) Ethanol Extract Cream as an Antioxidant Against Exposure to Ultraviolet B Rays in the Skin of Male Wistar (Rattus norvegicus) Rats Dewa Ayu Putu Sri Ista Dewanti; Desak Ketut Ernawati; Agung Wiwiek Indrayani; Ni Wayan Sucindra Dewi; I Made Jawi
Jurnal Epidemiologi Kesehatan Komunitas Vol 5, No 1: Februari 2020
Publisher : Master of Epidemiology, School of Postgraduate Studies, Diponegoro University, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (162.746 KB) | DOI: 10.14710/jekk.v5i1.6910

Abstract

Background: Indonesia is an archipelagic country and one of the tropical countries that get sun exposure all the time. Sun exposure can have beneficial and detrimental effects in life. Exposure to radiation can cause acute effects in the form of erythema through the inflammatory process. Antioxidants are substances that can protect the body from damage caused by ROS. Natural antioxidants can be found in vegetables and fruits, one of which comes from lemon extract (Citrus limon L.). Lemon extract is known to have various chemical contents with active compounds in the form of flavonoids and phenols which can act as antioxidants. The aim of this research was to determine the protective effect that can be produced by lemons on UVB exposure in the skin of male wistar rats.Methods: This research uses the true experimental post test only control group design method. Samples were divided into three treatment concentrations, namely ethanol extract of lemon 5%, 10%, and 20%.Result: After testing for normality, the significance value was obtained (p <0.05). Based on the results of the normality and homogeneity test, the results of the data distribution are not normal and the homogeneous tests of the hypotheses used are the Kruskal-Wallis non-parametric test. Kruskal-Wallis non-parametric test results showed a significant difference with the significance value (p = 0.001). The best degree of erythema score was found in the cream of 10% ethanol extract of lemon with an average of 0.8 ± 0.84.Conclusion : The ethanol extract of lemon (Citrus limon L.) cream in a certain dosage has a significant effect on reducing the erythema degree score in the back skin of male Wistar rats (Rattus norvegicus) after exposure to UVB rays.
IS INTERPROFESSIONAL PRACTICE (IPP) FOCUSED ON MEDICATION SAFETY FEASIBLE IN INDONESIA? A QUALITATIVE STUDY Desak Ketut Ernawati; Ya Ping Lee; Bruce Sunderland; Jeff Hughes
JURNAL MANAJEMEN DAN PELAYANAN FARMASI (Journal of Management and Pharmacy Practice) Vol 6, No 4
Publisher : Faculty of Pharmacy, Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/jmpf.356

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This paper explores facilitators for and barriers to the implementation of IPP focusing on medication safety in a public hospital in Bali, Indonesia. Qualitative methods involved interviews with stakeholders from a university and a hospital and focus group discussions with healthcare professionals in the hospital. Semi-structured questions were developed as a guide for the interviews and discussions. All interviews and discussions were recorded. The six steps of Braun and Clarke’s thematic analysis methodology were implemented in determining the themes. The Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist was employed in reporting of findings. Participants indicated that support from the government and perceived benefits of IPP were facilitators for IPP. However, the participants mostly mentioned the barriers of IPP including lack of competencies for IPP and lack of understanding of the role of other healthcare professionals as barriers to the implementation of IPP. This showed that these were the barriers identified to the implementation of IPP in the study hospital. Despite the fact that participants were supportive of IPP, the participants identified some barriers to the implementation of IPP in the study hospital. The implementation requires support of the government, professional organisations, and stakeholders at the university and hospital levels.
Analisis tingkat pengetahuan mahasiswa program studi pendidikan dokter tahun ajaran 2017-2018 Universitas Udayana tentang prescribing error Nabila Putri Rachmawati; Desak Ketut Ernawati; I Gusti Ayu Artini
Intisari Sains Medis Vol. 10 No. 1 (2019): (Available online 1 April 2019)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (293.127 KB) | DOI: 10.15562/ism.v10i1.197

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Introduction: Prescribing Errors is a failure in the treatment process leading to or potentially harmful to the patient, this error most often occurs although it can be prevented. The incidence of prescribing errors continues to increase from year to year, but data in Indonesia that discusses the level of knowledge of medical students about prescribing errors is still small. The purpose of this study is to determine the level of knowledge of medical student study program 2017-2018 academic year at Udayana University Denpasar about prescribing errors.Method: This research is a descriptive cross sectional study conducted at the Medical Faculty Udayana University Sudirman Campus Denpasar. Data obtained in the form of primary data questionnaire. Data were analyzed using software computer.Result: The results showed that the most gender are women of 68 students (66%). The largest proportion of age is 19-20 years old number of 52 students (52%). Groups of semesters 1, 3, 5 and 7 obatined a similar proportion of 25 students (25%). The level of students' knowledge of prescribing case study is classified into moderate category with mean 3,7-7,1 of 67 students (67%). The number of correct answers in identifying type of error from 3 prescriptions is in the case of the first prescription, the 3rd semester student who is able to identify the prescribing error, with the type of mistake that is wrong dose as many as 14 students (35,9%) with p value = 0,066 and wrong dosage form as 21 students (39,6%) with p value = 0.000. In the case of the second prescriptions, 7th semester students were able to identify the prescribing error, with the type of mistake that is wrong dose as many as 13 students (41,9%) with p value = 0,005 and wrong dosage form as 22 students (36,7%) with p value = 0.000. In the case of the third prescriptions, the 3rd semester students were able to identify the prescribing error, with the type of mistake that is the wrong indication of the drug as many as 15 students (62,5%) p value = 0.000.Conclusion: In this research, it can be concluded that the knowledge level of the majority students is in moderate levelabout 67 (67%). While the remaining respondents good knowledge level as much as 7 (7%) and bad knowledge is as much as 26 (26%).
Prevalensi dan faktor penentu prediabetes pada wanita muda obesitas di Kota Denpasar tahun 2019 Dinda Anggita Meiwita Sari; Desak Ketut Ernawati; Agung Nova Mahendra; I Wayan Weta
Intisari Sains Medis Vol. 11 No. 3 (2020): (Available online: 1 December 2020)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (288.884 KB) | DOI: 10.15562/ism.v11i3.701

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Background: The prevalence of prediabetic state in population is such a hard project to be confirmed within an increased number of obese population.Aim: The study aims to define the prevalence of prediabetes among obese young women (body mass index, BMI >25 kg/m2) in Denpasar.Methods: Research variables namely physical activity, food pattern, anthropometric values for identify level of obesity (light BMI 25-30, severe BMI >30 kg/m2), tipe of obesity (perifer obesity waist circumference <80 cm,  and central obesity waist circumference ≥80 cm), as well as fasting blood glucose (normal <100 mg/dL, prediabetes -125 mg/dL).Results: the prediabetes prevalence of subjects is 38,1%. All subjects 42 (100%) have light daily physical activity, with high mean of cholesterol intake (more than 200mg) and low of PUFA intake (less than 10% of fat intake). Pre-diabetic subjects have higher waist circumference (visceral fat) than subjects with normal blood glucose (p=0.023). In contrary, that was no relationship between subcutaneous fat (bicep and tricep skinfold) to prediabetic state(p >0,05). Central obesity was significant OR 1,76 (1,33-2,33) risk of prediabetes compared to peripheral obesity (p= 0,023). However, there was not significant risk (OR 2,67 (0,738-9,63) (p= 0,130)) of severe obesity to be prediabetes compared to light obesity. Latar Belakang: Peningkatan prevalensi obesitas bersamaan dengan prevalensi diabetes melitus tipe 2. Prevalensi prediabetes sangat susah dideteksi pada suatu populasi.Tujuan: untuk mengetahui prevalensi dan faktor penentu prediabetes pada wanita muda obese (indeks massa tubuh, IMT >25) di Denpasar.Metode: Penelitian ini termasuk studi cross-sectional dengan variabel penelitian, meliputi aktivitas fisik, pola makan, antropometri pada tingkat obesitas (obesitas ringan IMT 25-30 kg/m2, obesitas berat IMT>30 kg/m2) dan jenis obesitas (obesitas perifer lingkar perut <80 cm, obesitas sentral lingkar perut >80 cm), serta kadar glukosa darah puasa (normal <100 mg/dL, prediabetes -125 mg/dL).Hasil dan Simpulan: prevalensi prediabetes dari subjek adalah 38,1%. Semua subjek 42 (100%) memiliki aktivitas fisik harian yang ringan, dengan rata-rata asupan kolesterol yang tinggi (>200mg) dan asupan PUFA (pure unsaturated fatty-acid) yang rendah (<10% dari asupan lemak). Subjek dengan prediabetes mempunyai lingkar perut (lemak visceral) lebih besar dibandingkan dengan subjek dengan kadar gua darah normal (p=0,023). Sebaliknya, tidak didapat hubungan antara lemak subkutan (lipatan kulit bisep dan trisep) dengan kejadian prediabetes (p>0,05). Obesitas sentral bermakna berisiko menderita prediabetes OR 1,76 (1,33-2,33) dibandingkan dengan obesitas perifer (p= 0,023). Namun, tidak ada risiko yang signifikan [OR 2,67; (0,738-9,63) (p= 0,130)] obesitas berat menjadi prediabetes dibandingkan dengan obesitas ringan. 
Analisis kesesuaian pemakaian obat pada pasien asma dewasa dengan Peraturan Menteri Kesehatan Nomor 5 tahun 2014 di Badan Rumah Sakit Umum Daerah Kabupaten Tabanan tahun 2018 Desak Gede Vicsilia Mahambara Gita; Desak Ketut Ernawati; Agung Nova Mahendra
Intisari Sains Medis Vol. 11 No. 3 (2020): (Available online: 1 December 2020)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (290.389 KB) | DOI: 10.15562/ism.v11i3.737

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Background: Regulation of the Minister of Health of the Republic of Indonesia No. 5 of 2014 concerning asthma mentions the presence of types of asthma, medication controller, alternatives such as drugs and substances that have been determined and also other alternatives such as additional drugs. The drugs used in the guidelines were glucocorticosteroids, theophylline, chromolin, leukotriene modifiers, ventolin, and formeterol. Nowadays, the number of asthmatic patients who received asthma therapy according to that regulations had not been clearly distributed.Aim: The study aims to describe the pattern of drug use in adult asthma patients in accordance with the regulations in Tabanan General Hospital.Methods: A retrospective observational study with medical record data without providing intervention or treatment to samples in the Tabanan General Hospital in March-June 2019 aged 18-65 years and receiving asthma medication.Results and Conclusions: The three types of asthma, based on the type of drug, dosage, and dosage form are not in accordance with Regulation of Minister of Health No. 5 of 2014.  Peraturan Menteri Kesehatan (PMK) Republik Indonesia No 5 Tahun 2014 tentang asma menyebutkan adanya jenis asma, medikasi pengontrol, alternatif seperti obat dan zat yang telah ditentukan dan juga alternatif lain seperti tambahan obatnya. Obat yang digunakan pedoman PMK No 5 Tahun 2014 yaitu glukokortikosteroid, teofilin, kromolin, leukotrien modifiers, ventolin, formeterol. Sampai sekarang jumlah pasien asma yang mendapatkan terapi asma sesuai dengan PMK masih belum terdistribusi dengan jelas.Tujuan: untuk mendeskripsikan pola penggunaan obat pada pasien asma dewasa sesuai dengan PMK No 5 Tahun 2014 yang berlaku di Badan Rumah Sakit Umum Daerah (BRSUD) Kabupaten Tabanan.Metode: Penelitian observasional retrosprektif dengan data rekam medis tanpa memberikan intervensi atau perlakuan pada sampel di BRSUD Kabupaten Tabanan pada bulan Maret-Juni 2019 berusia 18-65 tahun dan mendapatkan terapi obat asma.Hasil dan Simpulan: Ketiga jenis asma, berdasarkan jenis obat, dosis, dan bentuk sediaan tidak sesuai dengan PMK No 5 Tahun 2014.
PELATIHAN PEMBUATAN SABUN PADAT DAN CAIR BERBAHAN EKSTRAK RIMPANG TEMULAWAK DAN SAMBILOTO PADA IBU-IBU PKK DESA MAMBANG, SELEMADEG TIMUR, TABANAN I.G.A. Artini; A.W. Indrayani; N.W.S. Dewi; I.W. Sumardika; I.G.M.G.S.C. Trapika; I.M. Jawi; B.K. Satriyasa; I.G.M. Aman; A.N. Mahendra; I.A.A. Widhiartini; D.K. Ernawati; N.W. Tianing; N.L. Suriani; I.G. Wiranatha
Buletin Udayana Mengabdi Vol 22 No 2 (2023): Buletin Udayana Mengabdi
Publisher : Lembaga Penelitian dan Pengabdian kepada Masyarakat

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24843/BUM.2023.v22.i02.p03

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Temulawak is one of medicinal plants which possess antibacterial activity against two major causes of infection in acne namely Staphylococcus epidermidis and Propionibacterium acnes. The active compounds of temulawak are curcumin and xanthorrhizol essential oil, which possess antibacterial activity as antiseptic and antibiotic. Sambiloto (known as Andrographis paniculate), contains active compound andrographolide, which is also assumed to possess antibacterial activity. This community program was the implementation of our research for community wellbeing, which aimed to raise the knowledge and skill of PKK women at Mambang village, Selemadeg Timur, Tabanan especially in producing liquid and solid soap from natural substances (temulawak and sambiloto extract). The program was conducted by visiting our partner company PT Bali Tangi and training for liquid and solid soap production from temulawak and sambiloto (as one form of temulawak and sambiloto utilization for skin health especially for acne management). We assess participant knowledge improvement by using questionaire before and after conducting the activity. There was an improvement in participant knowledge regarding the production of soap from natural substances (temulawak and sambiloto). In conclusion, this program had increase the knowledge and skill of PKK women at Mambang village regarding liquid and solid soap production from natural substances. Keywords: antiacne, liquid soap, sambiloto, solid soap, temulawak
PEMANFAATAN JAMU HERBAL UNTUK MENINGKATKAN IMUNITAS TUBUH DI ERA PANDEMI COVID-19 I.G.A. Artini; I.G.M.G.S.C. Trapika; N.W.S. Dewi; A.W. Indrayani; I.W. Sumardika; I.M. Jawi; B.K. Satriyasa; I.G.M. Aman; A.N. Mahendra; I.A.A. Widhiartini; D.K. Ernawati
Buletin Udayana Mengabdi Vol 22 No 4 (2023): Buletin Udayana Mengabdi
Publisher : Lembaga Penelitian dan Pengabdian kepada Masyarakat

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24843/BUM.2023.v22.i04.p02

Abstract

To date, COVID-19 infection still become an important health problem in Indonesia, including Bali. We may concern about this situation since there has been no specific drug or vaccine available against COVID-19 infection. In this new normal era, we should maintain our immunity to prevent the infection. Some herbs potentially possess great effect on maintaining immunity to protect ourselves from COVID-19 infection, such as kunyit, temulawak, jahe, kencur, pegagan and kelor. To date, herbs utilization for health in Banjar Sambahan remains very limited. This is related to the limited skill in processing herbal drink (jamu). This activity aimed to raise participant (PKK women at Banjar Sambahan) knowledge, as well as skills, on producing herbal drinks (jamu/loloh) that potentially increase the immunity during COVID-19 pandemic era. This programme was performed by socialization about herbs utilization for health (especially for immunity), accompanied by training (by video) on producing herbal drink and survey for herbal medicine utilization in community. The results of this programme were video, publication on national journal (SINTA indexed) and presentation on national scientific meeting. It can be concluded that this activity supply knowledge and skill for PKK women at Banjar Sambahan in processing herbal drink for maintaining the immunity against COVID-19 infection. Keywords: covid-19, immune, herbal drink, community service
SURVEY TENTANG KEMAMPUAN BEKERJA SAMA APOTEKER DI BALI Desak Ketut Ernawati; Ketut Agus Adrianta
Kartika : Jurnal Ilmiah Farmasi Vol 7 No 1 (2019)
Publisher : Fakultas Farmasi Universitas Jenderal Achmad Yani, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.26874/kjif.v7i1.171

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Abstrak Tenaga kesehatan diharapkan mampu bekerja sama dengan profesi lain pada pelayanan kesehatan sehingga kurangnya kemampuan bekerja sama dapat menghambat pelayanan kesehatan yang efektif. Penelitian ini dilakukan untuk mengetahui pemahaman apoteker dalam bekerja sama dengan profesi lain. Penelitian merupakan penelitian potong selintang dengan menggunakan survey kolaborasi yang terdiri dari 13 pernyataan tentang pemahaman kemampuan bekerja sama yang diberikan skala dari tidak ada sampai sangat baik (1-5). Faktor yang diteliti adalah pengetahuan dan ketrampilan bekerja sama. Survey menggali hal-hal yang dibutuhkan oleh apoteker dalam bekerja sama dengan profesi kesehatan lain dan hambatan apoteker dalam bekerja sama dengan profesi lain. Survey diberikan kepada seluruh apoteker yang menghadiri Konferensi Daerah di Bali pada pertengahan Tahun 2018. Data dianalisa dengan menggunakan SPSS versi 22. Total responden yang mengikuti survey adalah 274, 52,8% responden bekerja di apotek, 24,7% bekerja di dan 5% bekerja di klinik. Analisis Anova menunjukkan terdapat perbedaan bermakna dalam pengetahuan (p=0,001) dan ketrampilan dalam bekerja sama (p=0,03) berdasarkan tempat bekerja. Hasil kualitatif diperoleh hasil bahwa hal yang dianggap penting oleh apoteker dalam berkolaborasi antara lain kemampuan berkomunikasi, adanya wadah untuk berkomunikasi serta pemahaman tentang peranan tugas dan tanggungjawab profesi lain sehingga kurangnya hal l tersebut merupakan faktor penghambat kemampuan bekerja sama dengan profesi lain. Disarankan dimasa depan diperlukan kegiatan yang dapat meningkatkan kemampuan bekerja sama antar profesi kesehatan.   Kata kunci: Apoteker, ketrampilan, pengetahuan bekerja sama A survey of collaborative competencies amongst pharmacist in Bali  Abstract Healthcare professional are expected to be able to work together with other professions in the health service. So that the lack of ability to work together can hamper effective health services. This research was conducted to determine the understanding of pharmacists in collaboration with other professions. The research is a cross-sectional study using a collaborative survey consisting of 13 statements about understanding the ability to work together given a scale from none to very good (1-5). The factors studied are the knowledge and skills to work together. The survey explores the things needed by pharmacists in working with other health professions and the obstacles of pharmacists in working with other professions. The survey was given to all pharmacists who attended the Regional Conference in Bali in mid-2018. Data were analysed using SPSS version 22. Total respondents who took the survey were 274, 52.8% of respondents worked in pharmacies, 24.7% worked in and 5% work in the clinic. Anova analysis showed that there were significant differences in knowledge (p = 0.001) and skills in working together (p = 0.03) based on the place of work. Qualitative results obtained result that what is considered important by pharmacists in collaboration include the ability to communicate, the existence of a place to communicate and an understanding of the role of duties and responsibilities of other professions so that this lack of l is an obstacle to the ability to cooperate with other professions. It is suggested that in the future activities are needed that can improve the ability to work together between healthcare professional. Keywords: Knowledge in collaboration; skills in collaboration; pharmacist
PHOTOCHEMICAL ANALYSIS AND IN VITRO ANTI BACTERIAL ACTIVITY TESTING ETHANOL EXTRACTS OF YOUNG AND OLD AVOCADO LEAF (Persea americana Mill.) AGAINST Klebsiella pneumoniae ATCC 13883 syahida, iin kurnia; Mahendra, Agung Nova; Dewi, Ni Wayan Sucindra; Ernawati, Desak Ketut
E-Jurnal Medika Udayana Vol 12 No 8 (2023): E-Jurnal Medika Udayana
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24843/MU.2023.V12.i08.P16

Abstract

Fast translate Icon translate Fast translate Icon translate ABSTRAK Mikroorganisme dalam tubuh dapat menyebabkan suatu infeksi. Penyakit infeksi dapat ditangani dengan pemberian antibiotik, namun penggunaan antibiotik yang irrasional dapat menyebabkan masalah resistensi antibiotik. Bakteri Klebsiella pneumoniae merupakan salah satu bakteri yang sudah banyak mengalami resistensi antibiotik dan menjadi penyebab utama pada kasus pneumonia di beberapa negara di dunia. Kandungan senyawa metabolit sekunder (flavonoid, alkaloid, tanin dan saponin) yang dilaporkan pada daun alpukat (Persea americana Mill.) dipercaya memiliki aktivitas anti bakteri. Penelitian sebelumnya menunjukan bahwa ekstrak daun alpukat dapat menghambat pertumbuhan pada bakteri gram positif dan gram negatif. Tujuan penelitian ini adalah untuk mengetahui apakah ekstrak etanol daun alpukat (Persea americana Mill.) dapat menghambat pertumbuhan bakteri Klebsiella pneumoniae ATCC 13883 secara invitro. Metode yang digunakan adalah ekstraksi daun alpukat muda dan tua dengan pelarut etanol 96% yang terbagi dalam lima konsentrasi (20%, 40%, 60%, 80%, 100%). Pengujian antibakteri dilakukan secara difusi agar (Kirby Bauer) menggunakan teknik disc diffusion. Serta dilakukannya uji fitokimia metabolit sekunder secara kualitatif. Hasil menunjukan bahwa tidak ditemukan adanya clear zone disekitar cakram yang mengandung ekstrak pada semua konsentrasi. Simpulan Pada penelitian ini ekstrak daun alpukat dari kintamani tidak ditemukan aktivitas antibakteri terhadap bakteri Klebsiella pneumoniae. Kata Kunci: Antibakteri, Daun Alpukat, Klebsiella pneumoniae