UNS — Antimicrobial resistance (AMR) is one of the serious and complex community health problems. AMR is a condition when an infectious disease pathogen becomes resistant to the antimicrobial used to treat it.
In a study conducted by the Faculty of Medical Science (FK) Universitas Sebelas Maret (UNS) Surakarta and Kirby Institute UNSW Sydney, Universitas Gadjah Mada, Ministry of Health Indonesia, London School of Hygiene & Tropical Medicine, University College London, and The George Institute for Global Health, to improve the distribution of antimicrobial medicines wisely in the community to reduce the spread of AMR.
AMR occurs due to the misuse or over usage of antimicrobial medicines. Mainly because of the free antimicrobial medicines sales by several private apothecaries and drugstores. “Private apothecaries and drugstores often located in strategic, trusted, and accessible location, and provide essential medicines. However, there is a concern over inappropriate medicinal use in the community that will lead to AMR,” Prof. Virginia Wiseman from Kirby Institute, the lead researcher, explained.
Prof. Wiseman added that full comprehension of the level of this issue is needed to solve this problem. “Therefore, in the partnership between Antimicrobial Resistance Control Committee (KPRA) under the Ministry of Health, Indonesia needs to conduct a comprehensive study,” Prof. Wiseman stated.
This study involved a mystery client visiting private apothecaries and drugstores in Bekasi City, West Java, and Tabalong District, South Kalimantan. The mystery client expressed different symptoms and recorded every interaction detail. The research team conducted 495 visitations to private apothecaries and drugstores. From 70% of visitations, the team found antimicrobial drugs given without prescription. Providing antimicrobial without prescription is prohibited according to the Law in the Ministry of Health Decree (Permenkes).
“The finding shows that more than two-thirds of visitations to private apothecaries and drugstores in Indonesia, there was one type of antibiotics without prescription and often without appropriate suggestions from healthcare workers. This is very concerning. Even there are several second-line antibiotics which should be prescribed under an exceptional circumstance,” Prof. Wiseman concluded.
Profit, Regulation, and Cultural Changes
dr. Luh Putu Lila Wulandari, research fellow di Kirby Institute, as the first author in the paper published in BMJ Global Health, stated that the data collection process was conducted under a qualitative approach to explore the reasons from private apothecaries and drugstores that sell antimicrobial medicines without prescriptions.
“Many (private apothecaries and drugstores) felt pressurized by buyers. This shows that this issue is complex. Although, there is a motivation to generate profits. However, providing these medicines without prescription is considered a norm. Thus, it shows the need to revise the regulation and culture on the sales of antibiotics,” she stated.
Prof. Ari Probandari, the main researcher in PINTAR UNS, stated that there is tremendous pressure on the healthcare system in Indonesia, which increases in complexity due to the Covid-19 pandemic. “Sales of antibiotics that have not been regulated appropriately need to be managed soon. In many cases, Covid-19 has worsened the issues surrounding free antimicrobial. There is an increase in the number of sick people or people scared to get sick, who try to find medical advice and antimicrobial medicines from anywhere,” she explained.
According to Prof. Probandari, a multi-aspect approach is strongly needed. The community needs to consider the need to maximize the profit at private apothecaries and drugstores, the high demand for antimicrobial medicines from consumers, and encouragement from owners to compete with other drugstores.
“The good news is the Ministry of Health Indonesia makes this issue a priority and allocated resources to find a solution,” she added.
This study was conducted as a part of Protecting Indonesia from the Threat of Antibiotic Resistance (PINTAR) and supported by Indo-Pacific Health and Safety Centre, Department of Foreign Affairs and Trade (DFAT) under the Australian Government’s Health Security Initiative. Under this study, the PINTAR team collaborated with Indonesia’s government to develop a strategy to improve the use of antimicrobial drugs in the private sector. Further information on the PINTAR project can be accessed in www.pintarstudy.org. Humas UNS
Reporter: Bayu Aji Prasetya
Editor: Dwi Hastuti