Recent research conducted by Universitas Gadjah Mada, Sebelas Maret University, the Antibiotics Resistance Control Committee of the Indonesian Ministry of Health, the Kirby Institute of UNSW Sydney, the George Institute for Global Health of UNSW Sydney, London School of Hygiene & Tropical Medicine, and University College London discovered that two-thirds of pharmacies and drug outlets in Indonesia dispense unprescribed antibiotics to the public.
Responding to these findings, Professor Tri Wibawa of the UGM Faculty of Medicine encouraged relevant parties to control the potentially harmful practice. The imprudent, excessive, and irrational use of antibiotics can lead to antibiotic resistance. This major threat will put the world in danger, triggering an increase in morbidity and mortality, a spread of antibiotic-resistant bacteria, post-treatment relapses, prolonged hospital stays, and excess medical costs.
“Controlling the circulation of antibiotics in the community is vital to avoid bacterial resistance to antibiotics,” said Tri.
Leader of the research Professor Virginia Wiseman of the Kirby Institute said the research was conducted using mystery client methodology to assess pharmacies and private drug stores in Bekasi City, West Java Province, and Tabalong Regency, South Kalimantan Province. Of a total of 495 visits, researchers found the majority of the samples violated the regulation of antibiotics dispensing practices.
“In more than two-thirds of our visits, we can get one type of antibiotic without a prescription. Often, the pertinent healthcare workers provide incomplete advice on its use. It is very concerning because the list includes several second-line antibiotics that should only be prescribed under specific circumstances,” explained Virginia.
A research fellow at the Kirby Institute, Luh Putu Lila Wulandari, disclosed the pressure from customers was among the underlying reasons for such practice. Despite the motivation to seek profits, the unprescribed drug administration is considered the norm. Thus, in the future, changes in regulations and culture surrounding antibiotics must take place.
“It is complex. Many feel pressured by customers,” said Wulandari.
Professor Ari Natalia Probandari of Sebelas Maret University added that there was a fair amount of pressure on the healthcare system in Indonesia. The situation has become even more complicated due to the current pandemic. The antibiotics dispensing practices that have not been regulated properly require prompt intervention. The government and related parties must consider many aspects ranging from the stores’ need to maximize profits, the public’s high demand for antibiotics to owners’ competition in the industry.
“In many ways, the COVID-19 pandemic has exacerbated the problem of over-the-counter use of antibiotics. More and more people are sick or afraid of getting sick and seeking medical advice and drugs like antibiotics everywhere. The good news is, the Health Ministry considers this a priority and is allocating resources to find a solution,” said the Professor.
This research was conducted as part of Protecting Indonesia from the Threat of Antibiotic Resistance (PINTAR) project and supported by a grant from the Indo-Pacific Center for Health Security (DFAT) under the Australian Government’s Health Security Initiative. PINTAR aims to improve the use of antibiotics and reduce the global spread of antimicrobial resistance. The results of this study have been published in the BMJ Global Health.