Thursday, November 3, 2016
Indonesia - Indonesia takes pains to stop excessive use of antibiotics
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