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

Abstract

Introduction A major driver of antimicrobial resistance (AMR) and poor clinical outcomes is suboptimal antibiotic use, although data are lacking in low-resource settings. We reviewed studies on systemic antibiotic use (WHO ATC/DDD category J01) for human health in Indonesia, and synthesized available evidence to identify opportunities for intervention. Methods We systematically searched five international and national databases for eligible peer-reviewed articles, in English and Indonesian, published between 1 January 2000 and 1 June 2021 including: 1) antibiotic consumption; 2) prescribing appropriateness; 3) antimicrobial stewardship (AMS); 4) perceptions among consumers and providers. Two independent reviewers included studies and extracted data. Study-level data were summarized using random-effects model meta-analysis for consumption and prescribing appropriateness, effect direction analysis for AMS interventions, and qualitative synthesis for perception surveys. (PROSPERO CRD42019134641) Results Of 9323 search hits, we included 100 reports on antibiotic consumption (20), prescribing appropriateness (49), AMS (13), and/or perception (25) (8 categorized in >1 domain). The pooled estimate of overall antibiotic consumption was 110.1 DDD/100 patient-days (95%CI98.5-121.6), with ceftriaxone, ampicillin and levofloxacin being most consumed. Pooled estimates for overall appropriate prescribing (according to Gyssens method) were 33.5% (95%CI18.1-53.4%) in hospitals and 49.4% (95%CI23.7-75.4%) in primary care. Pooled estimates for appropriate prescribing (according to reference guidelines) were, in hospitals, 99.7% (95%CI97.4-100%) for indication, 84.9% (95%CI38.5-98.0%) for drug choice, and 6.1% (95%CI0.2-63.2%) for overall appropriateness, and, in primary care, 98.9% (95%CI60.9-100%) for indication, 82.6% (95%CI50.5%-95.7%) for drug choice and 10.5% (95%CI0.8-62.6%) for overall appropriateness. The few AMS intervention studies conducted to date suggested potential to reduce antibiotic consumption and improve prescribing appropriateness. Key themes identified in perception surveys were lack of antibiotic knowledge among consumers and non-prescription antibiotic self-medication. Conclusions Context-specific strategies are urgently needed to improve rational antibiotic use in Indonesian hospitals and communities, with critical evidence gaps concerning private and informal health providers.

Characteristics of patients associated with antibiotic use among gastrointestinal surgery at the Academic Hospital, Universitas Gadjah Mada

“…23 The Gyssens method is an instrument that is widely used to evaluate the appropriateness of using antibiotics in the treatment of patients. 22,24,25 The present study showed various causes of irrational use of antibiotics, either as prophylactic or therapeutic. Both the use of other antibiotics should be more efficient, and the inappropriate doses were the main category that often led to irrational assessments of the use of these antibiotics.…”

“…11 Based on a systematic review, it was also stated that those included in the top 15 antibiotics most commonly consumed in Indonesia are β-lactams, especially cephalosporin and penicillins. 22 Bacterial culture was not usually performed on digestive surgery patients. The therapeutic antibiotic used in the present study was empirical antibiotics.…”

Interprofessional Collaboration On Non-Communicable Disease Programs (NDP) In Primary Health Services

“…It is predicted that NDP will continue to increase. NDP is a challenge in the world of health (Limato et al, 2022).…”