Abstract
Background
Inappropriate antibiotic therapy is accelerating the development of antimicrobial resistance (AMR). Upper respiratory tract infections (URTIs) are predominantly caused by viruses, resulting in the prescription of antibiotics to a few selected patients. Previous studies in primary health care centers (PHCCs) in Indonesia have shown a high percentage of antibiotic therapy for URTIs. This study tries to analyze the difference in profiles of antibiotic prescription in the treatment of children and adults with URTI in Bangka Tengah, Indonesia.
Methods
Random prescriptions from patients diagnosed with URTIs (sinusitis, bronchitis, common cold, and pharyngitis) from all PHCCs in Bangka Tengah were collected from January to February 2018. Prescriptions from patients with overlapping diagnoses, such as URTI with diarrhea or typhoid, were excluded.
Results
During the two months of data collection, 1348 prescriptions for adults and children with URTIs were studied. Children were 1.30 (95% CI, 1.03–1.58) times more likely to be treated with antibiotics compared to adults. Amoxicillin was the most commonly prescribed antibiotic both in children (92.3%) and adults (78.6%). Ciprofloxacin was commonly prescribed in adults (14.6%) but not in children (0.3%).
Conclusions
This study confirms the major antibiotic overuse in patients with URTI, especially in children. Owing to the fact that children are more likely to get URTI of viral origin, they receive high percentage of antibiotic therapy. These findings support the need for collaborated intervention to decrease unnecessary prescription of antibiotics in Bangka Tengah.
Research funding: We thank to Tahir Foundation professorship program (Dr. Suharjono) for supporting the study.
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: Authors state no conflict of interest.
References
[1] World Health Organization. Global action plan on antimicrobial resistance. Geneva: World Health Organization, 2015. ISBN: 9789241509763. Accessed on 18th August 2019.Search in Google Scholar
[2] Davies J, Davies D. Origins and evolution of antibiotic resistance. Microbiol Mol Biol Rev 2010;74:417–33.10.1128/MMBR.00016-10Search in Google Scholar
[3] Ventola CL. The antibiotic resistance crisis: causes and threats. P T J 2015;40:277–83.Search in Google Scholar
[4] Andrajati R, Tilaqza A, Supardi S. Factors related to rational antibiotic prescriptions in community health centers in Depok City, Indonesia. J Infect Public Health 2017;10:41–8.10.1016/j.jiph.2016.01.012Search in Google Scholar
[5] Hadi U, Duerink DO, Lestari ES, Nagelkerke NJ, Werter S, Keuter M, et al. Survey of antibiotic use of individuals visiting public healthcare facilities in Indonesia. Int J Infect Dis 2008;12:622–9.10.1016/j.ijid.2008.01.002Search in Google Scholar
[6] Pradipta I, Kartikawati A, Hartanto H, Febrina E, Ronasih E, Abdulah R, et al. Three years of antibacterial consumption in Indonesian Community Health Centers: the application of anatomical therapeutic chemical/defined daily doses and drug utilization 90% method to monitor antibacterial use. J Fam Community Med 2015;22:101.10.4103/2230-8229.155385Search in Google Scholar
[7] Kemenkes RI. Laporan Nasional Riset Kesehatan Dasar 2018 (Report of Indonesian Basic Health Survey 2018). Jakarta, 2018.Search in Google Scholar
[8] Cotton MF, Innes S, Jaspan H, Madide A, Rabie H. Management of upper respiratory tract infections in children. South African Fam Pract 2008;50:6–12.10.1080/20786204.2008.10873685Search in Google Scholar
[9] Hastuti, Tambunan HP, Novian O, Heryanti V, Intan A. Profil kesehatan Provinsi Kepulauan Bangka Belitung 2017 [Internet]. 2017. Available at: http://dinkes.babelprov.go.id/content/profil-kesehatan-2017. Accessed: 27th August 2019. 2017.Search in Google Scholar
[10] Praptiningsih CY, Lafond KE, Wahyuningrum Y, Storms AD, Mangiri A, Iuliano AD, et al. Healthcare-seeking behaviors for acute respiratory illness in two communities of Java, Indonesia: a cross-sectional survey. J Epidemiol Glob Health 2016;6:77–86.10.1016/j.jegh.2016.01.002Search in Google Scholar
[11] Agustina R, Dartanto T, Sitompul R, Susiloretni KA, Suparmi, Achadi EL, et al. Universal health coverage in Indonesia: concept, progress, and challenges. Lancet 2019;393:75–102.10.1016/S0140-6736(18)31647-7Search in Google Scholar
[12] WHO Regional Office for South-East Asia. The Republic of Indonesia Health System Review, Vol. 7. World Health Organization, 2017:64–105. Available at: http://apps.who.int/iris/bitstream/10665/254716/1/9789290225164-eng.pdf. Accessed: 25th August 2019.Search in Google Scholar
[13] Kementerian Kesehatan Republik Indonesia. Peraturan Menteri Kesehatan Republik Indonesia Nomor 5 Tahun 2014 Tentang Panduan Praktik Klinis Bagi Dokter Di Fasilitas Pelayanan Kesehatan Primer, 2014.Search in Google Scholar
[14] Harris AM, Hicks LA, Qaseem A. Appropriate antibiotic use for acute respiratory tract infection in adults: advice for high-value care from the American College of Physicians and the Centers for Disease Control and Prevention. Ann Intern Med 2016;164:425.10.7326/M15-1840Search in Google Scholar PubMed
[15] Yoon YK, Park CS, Kim JW, Hwang K, Lee SY, Kim TH, et al. Guidelines for the antibiotic use in adults with acute upper respiratory tract infections. Infect Chemother 2017;49:326–52.10.3947/ic.2017.49.4.326Search in Google Scholar PubMed PubMed Central
[16] Alves Galvão MG, Rocha Crispino Santos MA, Alves da Cunha AJ. Antibiotics for preventing suppurative complications from undifferentiated acute respiratory infections in children under five years of age. Cochrane Database Syst Rev 2016. Available at: http://doi.wiley.com/10.1002/14651858.CD007880.pub3. Accessed: 27th August 2019.10.1002/14651858.CD007880.pub2Search in Google Scholar PubMed
[17] National Institute for Health and Clinical Excellence. Prescribing of antibiotics for self-limiting respiratory tract infections in adults and children in primary care. Respir Tract Infect – Antibiot Prescr 2008;69:1–240.Search in Google Scholar
[18] Thomas M, Bomar PA. Upper respiratory tract infection. StatPearls [Internet]. StatPearls Publishing, 2019. Available at: http://www.ncbi.nlm.nih.gov/pubmed/30422556. Accessed: 27th August 2019.Search in Google Scholar
[19] van Houten CB, Cohen A, Engelhard D, Hays JP, Karlsson R, Moore E, et al. Antibiotic misuse in respiratory tract infections in children and adults – a prospective, multicentre study (TAILORED treatment). Eur J Clin Microbiol Infect Dis 2019;38:505–14.10.1007/s10096-018-03454-2Search in Google Scholar PubMed PubMed Central
[20] Kementrian Kementrian Kesehatan Republik Indonesia (Indonesia Ministry of Health). Formularium Nasional 2017 (Indonesia National Formulary), 2017.Search in Google Scholar
[21] World Health Organization. WHO model list of essential medicines for children. WHO Model List of Essential Medicines, 2017 . Available at: http://www.who.int/medicines/publications/pharmacopoeia. Accessed: 6th August 2019.Search in Google Scholar
[22] World Health Organization. World Health Organization model list of essential medicines. List Essent Med 2017:1–45. Available at: http://www.who.int/medicines/publications/pharmacopoeia. Accessed: 6th August 2019.Search in Google Scholar
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