1. How are you and your work contributing to protect Indonesia from the threat of antibiotic resistance?
The Antimicrobial Resistance Control Committee (KPRA) of Indonesia’s Ministry of Health has data of AMR in Indonesia with the indicator Extended Spectrum Betalactamase (ESBL) producing E. coli and K. pneumonia, obtained from surveys conducted in 2013 and 2016. The prevalence was 40% (26.7%-=56,8%) and 60% (50%-82%) respectively. Almost 80% of physicians prescribed antibiotic inappropriately (KPRA MoH survey in 6 teaching hospitals in 2016).
The KPRA has already developed a Ministry decree in order to implement an AMR programme in hospital settings with accompanying guidelines and to strengthen awareness and understanding of AMR and related problems among providers at hospital level. An AMR workshop was held for at least 4 clinicians of each of 140 hospitals, funded by the Ministry of Health. There is a collaboration with the Hospital Accreditation Committee, which created 10 assessment elements for hospital audits of AMR programme implementation.
2. What are your thoughts on the role of the private sector in improving appropriate use of antibiotics?
Most physicians in the private sector are known to have contributed to a high use of antibiotics. The KPRA is already drafting the replacement of a previous Ministry decree, which will be used for the AMR programme in all health facilities including in the private sector. We hope it will be effective by early 2021.
3. What type of interventions involving private drug sellers could best inform AMR policy at national and international level?
The dispensing of antibiotics over the counter (OTC) should be banned gradually, because the regulation already exists. This can be done through law enforcement implementation, education for strengthening AMR awareness and understanding, and close monitoring and coordination by the Ministry of Health at district level.
4. In your view, how will the COVID-19 pandemic affect efforts to address AMR in Indonesia and similar countries?
COVID-19 cases have many clinical variances of doubt (viral vs. bacterial infections). The clinician tends to give empiric antibiotic for safety reasons, even if the bacterial infection only represents around 10% of COVID-19 cases. Data at a glance in COVID-19 wards of Dr. Soetomo hospital (in June 2020) shows antibiotic use in 70% of moderate cases and 100% in ICU patients. Antibiotic will be prescribed based on abnormality of single or more of WBC, CRP, PCT, CXR, fever or medical device intervention (e.g. ventilator).