In developing countries, it is a problem
decades old but the rising antimicrobial resistance in Indonesia has rarely
been raised in a public awareness campaign — even though the government has
quietly been putting in a great deal of effort to reverse the trend.
Few people may have even heard that the
Health Ministry runs a task force called the Antimicrobial Resistance Control
Committee, or KPRA. To support the antimicrobial resistance campaign, the task
force has been commissioned to draft a national action plan.
The basic concern over antibiotic resistance
is that it can reverse decades of advances in medicine, bringing the world back
to an age before the discovery of antibiotics, in 1928, when millions of people
died from infections that could have been prevented today.
In Indonesia, doctors now already have to
prescribe new types of antibiotics or higher dosages of current medicines
because the bacteria are getting stronger.
The action plan will dictate a nationwide
effort to reduce the abuse of antibiotics in human, animals and plants, as the
medicines are also often misused for treatment and prevention of diseases in
livestock, aquaculture, as well as crop production.
“If
antibiotics are used on livestock, they will infect people who consume its
products, such as meat and milk. This also applies to shrimp and fish. We also
have to monitor antibiotics used on them,” KPRA head Harry Parathon said.
According to the Agriculture Ministry,
unchecked use of antibiotics is also rampant among farmers without them knowing
it. The chemicals are found in the animals’ drinking fluids and feed.
Andi Hendra Purnama, a ministry official in
charge of monitoring animal feed, says some antibiotics are disguised as “feed
additive” as stated in their labeling.
Harry warns that excessive use of antibiotics
on livestock can also adversely affect plants.
“Let’s say I have a chicken farm and give
antibiotics to all of my chickens. Their feces on the soil find their way into
plants. As a result, the plants will absorb the antibiotics, creating a cycle.”
Hence the government will adopt the “One
Health” concept in its action plan. Introduced in the early 2000s, the concept
assumes that human and animal health are interdependent and bound to the health
of the ecosystems in which they exist.
The KPRA expects it will take a long time to
draft the national action plan because it is an interdepartmental undertaking
that involves such institutions as the Maritime Affairs and Fisheries Ministry
and the Agriculture Ministry.
The committee also aims to tackle other major
causes of the increasing antibiotic resistance in Indonesia, like public
misperception on antibiotics, unrestrained doctors’ antibiotic prescriptions
and easy access to antibiotics in the market.
A recent survey conducted by the Indonesian
Caring Parents Foundation (YOP) with 92 doctors in Jakarta and 35 doctors in
Papua found that 91 percent of the doctors always prescribe antibiotics to
their patients, while 75 percent of them prescribe antibiotics for mild
illnesses like the common cough and influenza.
According to the YOP survey, 85 percent of
pharmacies in Jakarta sell antibiotics without prescriptions. What’s more, 83
percent of them recommend that customers buy antibiotics, even when people only
ask for drugs for mild ailments, like the flu.
Research by the Health Ministry in 2013
showed that only 27 percent of doctors in Indonesia had given the right dose of
antibiotics and prescribed them for the right purposes.
It also gave a glimpse of how easy it was to
access antibiotics in Indonesia. The survey found that 10 percent of families
had antibiotics in their homes and that at least 86 percent of those obtained
the drug without a prescription.
It turns out that unnecessary antibiotics are
not only prescribed by doctors who open their private services, but also by
hospitals, as Harry has noted.
“Patients have already developed antibiotic
resistance from home. Then they are given antibiotics again at the hospital.
Instead of being killed, these bacteria grow stronger. This is called
healthcare associate infection. So the infection happens at hospitals,” Harry
said.
In response, Health Minister Nila F. Moeloek
has called on doctors to exercise maximum care in prescribing antibiotics.
She specifically asked the Indonesian Doctors
Association (IDI) to remind its members to not authorize the use of antibiotics
unless it is really necessary.
IDI secretary-general Adib Khumaidi promises
the association will take action against any of its members who go against the
rule. “Disciplinary actions will be in the form of membership termination or
suspension,” he says.
But IDI doctors have an excuse. Very often,
doctors prescribe antibiotics on the patient’s demand although they know the
medicines are unnecessary.
“Besides, patients sometimes buy antibiotics
over the counter because they know the drugs. We have to stop it,” Adib says.
Even worse is the fact that many people also
fail to take antibiotics in the right dosage or fail to get through their
prescriptions.
“Once patients begin taking antibiotics, they
can’t stop midway. They must finish their prescribed duration of taking the
drug,” Adib says.
Aside from the national action plan, the
ministry actually had issued a regulation in 2011, which serves as a general
guideline on antibiotic use. Then last year, it launched a campaign called
“GeMa CerMat”, aimed to encourage the public to wisely use antibiotics.
For a better grasp on this critical issue,
the government is currently researching the level of antibiotic resistance in
18 hospitals in major cities of the country.
Currently, it is assessing how well hospitals
have been implementing the antibiotic-resistant management program.
“If the prevalence of antibiotic resistance
is high in a hospital, its use must be unrestrained. And that hospital might
fail to get accreditation. So the assessment will become part of hospital
accreditation,” Harry says.
Hans Nicholas Jong
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