Optimizing antibiotic use in Indonesia: A systematic review and evidence synthesis to inform opportunities for intervention

Limato, Ralalicia; Lazarus, Gilbert; Dernison, Puck; Mudia, Manzilina; Alamanda, Monik; Nelwan, Erni Juwita; Sinto, Robert; Karuniawati, Anis; Doorn, H. Rogier van; Hamers, Raph L

doi:10.1016/j.lansea.2022.05.002

Cited by 19 publications

(20 citation statements)

References 99 publications

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“…29 in 1992, both for clinical and research purposes. 15,30 Compared to the Gyssens method, these 11 generic QIs by van den Bosch et. al.…”

Section: Discussionmentioning

confidence: 99%

“…A wide variation exists between hospitals, departments, work experience and medical hierarchy. 11,15 The utilization of QIs could potentially overcome these issues by introducing them as actionable points. The 11 generic QIs in this study would provide clear guidance on appropriate antibiotic prescribing and empower clinical decision-making.…”

Section: Discussionmentioning

confidence: 99%

“…Appropriate prescribing was estimated at 33.5% using the Gyssens method. 14,15 The quality of antibiotic prescribing practices in the country are not yet assessed with the implementation of QIs. 15 With many hospitals lacking the infrastructure to adequately measure process, outcome and structural indicators, such as insufficient training and infectious diseases and microbiology expertise, there is a need for QIs that are easily applicable and can soundly measure the quality of antibiotic use.…”

Section: Introductionmentioning

confidence: 99%

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The Clinimetric Profile of 11 Generic Quality Indicators for Appropriate Antibiotic Use in Hospitalized Patients in Indonesia

Tunjungputri,

Lie,

Susilo

et al. 2023

Preprint

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BackgroundOne of the efforts in antibiotic stewardship for limiting antibiotic resistance is the assessment of the quality of antibiotic use. To date, the quality and appropriateness of antibiotic use in Indonesia, a low-middle-income non-European country, have not yet been assessed using proven quality indicators (QIs). One recommended tool to measure appropriate empiric antibiotic use in hospitalized patients is the generic QIs reported by van den Boschet. al., which demonstrated good validity and generalizability.ObjectiveThe aim of this study is to assess the clinimetric profile of 11 generic QIs based on van den Boschet. al. in admitted adult patients receiving empiric antibiotics in Indonesian hospitals.MethodsThis is an observational study with a cross-sectional design conducted at two government referral hospitals in Jakarta, Indonesia, from August 1, 2022, to February 2, 2023. Adult inpatients who received empiric antibiotics due to suspected infection for ≥24 hours were included in the study.ResultsIn 500 inpatients from 2 hospitals, all QIs demonstrated good measurability with less than 10% of missing data. Ten QIs showed good applicability of >10%. Four QIs show good performance, while six QIs have significant potential for improvement (two blood cultures are obtained before empiric antibiotic treatment; culture sample is obtained from location suspected of infection; antibiotic is switched from intravenous to oral when clinically possible; antibiotics are stopped when there is no evidence of infection; a guideline is available and renewed every three years; and a guideline is adjusted to the local resistance pattern) making them priority targets for interventions to enhance the quality of antibiotic use in Indonesia. All QIs display good inter-observer reliability, and no moderate or strong correlations are found between QIs.ConclusionThe clinimetric assessment of QIs is imperative before their implementation in any setting different from their country of origin. Of the 11 generic QIs, 10 demonstrated good reliability and applicability at two hospitals in Indonesia. Future intervention studies can utilize these generic QIs to measure improvement in the appropriateness of antibiotic use.

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“…29 in 1992, both for clinical and research purposes. 15,30 Compared to the Gyssens method, these 11 generic QIs by van den Bosch et. al.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The Clinimetric Profile of 11 Generic Quality Indicators for Appropriate Antibiotic Use in Hospitalized Patients in Indonesia

Tunjungputri,

Lie,

Susilo

et al. 2023

Preprint

Self Cite

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“…Hadi et al (2008) also reported that 44-97% of patient antibiotic prescriptions were inappropriate or unnecessary in developing countries, while in Indonesia only 21% of prescriptions were considered appropriate. Limato et al (2022) conducted a systematic review demonstrates that among the populations that were studied in Indonesia, the appropriateness of antibiotic prescribing was found to be poor overall (35.3 percent), 49.4 percent in primary care versus 33.5 percent in hospitals.…”

Section: Introductionmentioning

confidence: 99%

Qualitative Evaluation of Antibiotic Use in Bacterial Meningitis Patients using the Gyssens Method

2023

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Meningitis bakterial dianggap sebagai kasus kegawatdaruratan neurologik dengan angka morbiditas dan mortalitas yang tinggi. Mortalitas akibat meningitis bakterial dapat mencapai 34% terutama pada infeksi yang disebabkan oleh S. pneumoniae dan L. meningitidis. Sementara morbiditas pada pasien meningitis bakterial yaitu sekuele neurologis jangka panjang dapat mencapai 50% pada survivor meningitis. Terapi antibiotik dengan penggunaan yang rasional dapat menurunkan angka kematian. Sebaliknya, penggunaan terapi antibiotik yang tidak rasional akan meningkatkan terjadinya resistensi yang berdampak pada peningkatan morbiditas, mortalitas, dan biaya kesehatan. Penelitian ini bertujuan untuk mengetahui kualitas penggunaan antibiotik pada pasien meningitis bakteri dengan metode Gyssens. Penelitian ini merupakan penelitian observasional dengan metode retrospektif cross-sectional yang dilakukan di Rumah Sakit Umum Fatmawati, Jakarta. Subyek penelitian adalah 24 pasien meningitis bakterial yang memenuhi kriteria inklusi. Pada penelitian ini, 45,8% subjek telah diberikan antibiotik yang tepat dan 54,2% yang tidak tepat, yang tersebar di

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Global antibiotic usage has hastened the problem of antimicrobial resistance in public health. [1][2][3][4] Antibiotic abuse and/or overuse has long been a public health concern, especially in many low-and middle-income Countries (LMIC). [5][6][7] Antimicrobial resistance develops naturally, but it is exacerbated globally by antibiotic overuse and misuse.

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mentioning

confidence: 99%

Antibiotic utilization profile in surgical ward at secondary government hospital

Marchiella,

Khairunnisa,

Wiryanto

2023

Int J Basic Clin Pharmacol

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Background: This study aimed to determine the profile of the antibiotic utilization in defined daily dose (DDD) units and DU 90% at surgical ward of secondary government hospital in Indonesia within six months period of study. Methods: A retrospective cross-sectional study was conducted over six months on surgical ward patients prescribed with at least one oral or parenteral antibiotic during hospitalization. Data were collected from pharmacy dispensing data and evaluated using World Health Organization (WHO) DDD. Antibiotics DDD were analysed using DU 90% segmentation in order to know the 90 percent cumulative of antibiotic consumption in surgical ward. WHO prescribing indicators were used to examine the antibiotic prescribing pattern in DU 90% segment. Results: Out of 319 antibiotic prescribed to surgical ward patients, 219 prescriptions were belonging to DU 90% segment including ceftriaxone (38.94%), moxifloxacin (16.41%), fosfomycin (14.06%), metronidazole (12.43%), and gentamicin (7.69%) in decreasing fashioned. Of the five groups of antibiotics belong to DU90%, ceftriaxone was the highest in DDD (272.5). The average number of antibiotic prescribed to patients were 1.64±0.92. The percentage of antibiotic prescribed by its generic name as well the prescribing of antibiotic from National list of essential medicines were 70.79% and 72.51%, respectively (optimal value 100%). Conclusions: Our findings on using drug utilization 90% and prescribing indicators are practical for assessing the most widely used antibiotics in ward or hospital setting and to evaluate the quality of prescribing pattern. The antibiotic utilization profile in this study can be used to provide comparative data between hospital and beneficial for future policy making to improve prescribing practice.

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Optimizing antibiotic use in Indonesia: A systematic review and evidence synthesis to inform opportunities for intervention

Cited by 19 publications

References 99 publications

The Clinimetric Profile of 11 Generic Quality Indicators for Appropriate Antibiotic Use in Hospitalized Patients in Indonesia

The Clinimetric Profile of 11 Generic Quality Indicators for Appropriate Antibiotic Use in Hospitalized Patients in Indonesia

Qualitative Evaluation of Antibiotic Use in Bacterial Meningitis Patients using the Gyssens Method

Antibiotic utilization profile in surgical ward at secondary government hospital

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