ANTIBIOTICS IN INDONESIA: ACCESS, WATCH, AND RESERVE CLASSIFICATION

Authors

  • DIRGAHAYUNI SARI AGUSTINA AMBARITA Master Program of Public Health Science, Faculty of Public Health, University of Indonesia, Depok-16424, Indonesia https://orcid.org/0009-0009-6197-0506
  • PUPUT OKTAMIANTI Department of Health Policy and Administration, Faculty of Public Health, University of Indonesia, Depok-16424, Indonesia
  • I GUSTI AYU TRISNADEWI Directorate General of Pharmaceutical and Medical Devices, Ministry of Health, Jakarta-12950, Indonesia

DOI:

https://doi.org/10.22159/ijap.2024v16i3.50351

Keywords:

Antibiotics, AWaRe, National essential medicines list, National formulary, Indonesia

Abstract

Objective: The objective of this study is to compare antibiotics listed in the National Essential Medicines List (NEML) and national formulary in Indonesia by determining the proportion of antibiotics in the three groups, Access, Watch, and Reserve (AWaRe), along with median data, range values, and time trends from 2013 to 2021.

Methods: We obtained the compilation of antibiotics from the NEML and national formulary in Indonesia, covering the period from 2013 to 2021. These antibiotics were evaluated according to the 2021 WHO AWaRe classification database. This analysis involved determining the proportion of antibiotics in the AwaRe groups within each healthcare facility. Median data and range values for these antibiotics were also calculated. Trends in the proportion of AWaRe antibiotics were analyzed and visualized using a line chart.

Results: The Indonesian NEML includes 20 antibiotics, categorized into two tiers of healthcare settings. Of these antibiotics, 13 were access, seven were watch, and there was neither a reserve nor a not recommended antibiotic. The Indonesian national formulary includes 42 antibiotics, categorized into three tiers of healthcare settings. Of these antibiotics, 19 were access, 22 were watch, one was not recommended, and there was no reserve antibiotic. The proportion of antibiotics during the pre-and post-establishment of the WHO AWaRe in 2017 showed significant changes in the Indonesian national formulary but not in the NEML.

Conclusion: In recent years, the proportions of antibiotics in the Indonesian NEML and national formulary have varied according to the WHO AWaRe classification.

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References

Antimicrobial Resistance Collaborators. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet. 2022;399(10325):629-55. doi: 10.1016/S0140-6736(21)02724-0, PMID 35065702.

World Health Organization. Antimicrobial resistance. Geneva: World Health Organization; 2020. Available from: https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance. [Last accessed on 21 Feb 2023]

Sriram A, Kalanxhi E, Kapoor G, Craig J, Balasubramanian R, Brar S. State of the world’s antibiotics 2021: a global analysis of antimicrobial resistance and its drivers. Washington, DC: Center for Disease Dynamics, Economics and Policy; 2021.

C Denny, Karan S. Antibiotic resistance (ABR) and community pharmacist: a review. Asian J Pharm Clin Res. 2021;14(9):37-9. doi: 10.22159/ajpcr.2021.v14i9.42018.

Limato R, Lazarus G, Dernison P, Mudia M, Alamanda M, Nelwan EJ. Optimizing antibiotic use in Indonesia: a systematic review and evidence synthesis to inform opportunities for intervention. Lancet Reg Health-Southeast Asia. 2022;2:100013. doi: 10.1016/j.lansea.2022.05.002.

World Health Organization. Global action plan on antimicrobial resistance. Geneva: World Health Organization; 2015.

Hussain S, Yadav SS, Sawlani KK, Usman K, Khattri S. Antimicrobial agent’s utilization and cost pattern in medical intensive care unit of a tertiary care hospital. Int J Pharm Pharm Sci. 2021;13(8):89-93. doi: 10.22159/ijpps.2021v13i8.41338.

World Health Organization. World Health Organization model list of essential medicines: 22nd list. Geneva: World Health Organization; 2021.

Adekoya I, Maraj D, Steiner L, Yaphe H, Moja L, Magrini N. Comparison of antibiotics included in national essential medicines lists of 138 countries using the WHO Access, Watch, Reserve (AWaRe) classification: a cross-sectional study. Lancet Infect Dis. 2021;21(10):1429-40. doi: 10.1016/S1473-3099(20)30854-9, PMID 34332706.

Tisocki K. How to develop a national formulary based on the WHO model formulary: a practical guide Laing R, editor. Geneva: World Health Organization; 2004.

Chaurasiya VR. The pattern of drug uses in pregnant women attending the antenatal clinic of the obstetrics and gynaecology department at a tertiary care hospital. Asian J Pharm Clin Res. 2022;15(9):149-54. doi: 10.22159/ajpcr.2022.v15i9.45028.

Kementerian Kesehatan Republik Indonesia. Keputusan Menteri Kesehatan Republik Indonesia Nomor 312/MENKES/SK/IX/2013 tentang daftar obat esensial nasional; 2013.

Kementerian Kesehatan Republik Indonesia. Keputusan Menteri Kesehatan Republ Indones Nomor HK.01.07/MENKES/6485/2021 tentang formularium nasional; 2022.

Kesehatan BPJS, Data JKN. Jakarta: BPJS Kesehatan; 2023. Available from: https://bpjs-kesehatan.go.id/#. [Last accessed on 28 Jul 2023]

Badan Pusat Statistik. Jumlah penduduk pertengahan tahun (ribu jiwa), 2021-2023. Jakarta: Badan Pusat Statistik; 2023. Available from: https://www.bps.go.id/indicator/12/1975/1/jumlah-penduduk-pertengahan-tahun.html. [Last accessed on 28 Jul 2023]

Kemkes. Kementerian kesehatan republik Indonesia. Jakarta: Direktorat Jenderal Kefarmasian dan Alat Kesehatan; 2023. Available from: https://farmalkes.go.id/?page_id=6144. [Last accessed on 21 Jul 2023]

WHO Collaborating Centre for Drug Statistics Methodology. ATC/DDD index. Geneva: WHO Collaborating Centre for Drug Statistics Methodology; 2023. Available from: https://www.whocc.no/atc_ddd_index/?code=J01andshowdescription=no. [Last accessed on 23 Jul 2023]

World Health Organization. WHO Access, Watch, Reserve (AWaRe) classification of antibiotics for evaluation and monitoring of use. Geneva: World Health Organization; 2021.

Republik Indonesia. Undang-undang Republik Indonesia Nomor 17 Tahun 2023 tentang kesehatan. 2023;105:LN2023.

Kementerian Kesehatan Republik Indonesia. Peraturan Menteri Kesehatan Republik Indonesia Nomor 54 Tahun 2018 tentang penyusunan dan penerapan formularium nasional dalam penyelenggaraan program jaminan kesehatan. Vol. 10; 2019.

Bazargani YT, Ewen M, De Boer A, Leufkens HGM, Mantel Teeuwisse AK. Essential medicines are more available than other medicines around the globe. PLOS ONE. 2014;9(2):e87576. doi: 10.1371/journal.pone.0087576, PMID 24533058.

World Health Organization. Review of antibiotics in national medicines selection lists in Eastern Europe and Central Asia. Geneva: WHO Regional Office for Europe; 2023.

Chua AQ, Verma M, Hsu LY, Legido Quigley H. An analysis of national action plans on antimicrobial resistance in Southeast Asia using a governance framework approach. Lancet Reg Health West Pac. 2021;7:100084. doi: 10.1016/j.lanwpc.2020.100084, PMID 34327414.

World Health Organization. AWaRe classification. Geneva: World Health Organization; 2021. Available from: https://www.who.int/publications/i/item/2021-aware-classification. [Last accessed on 03 Mar 2023]

Kementerian kesehatan republik Indonesia. Keputusan Menteri Kesehatan Republ Indones Nomor HK.01.07/MENKES/6477/2021 tentang daftar obat esensial nasional; 2021.

Kementerian Kesehatan Republik Indonesia. Peraturan Menteri Kesehatan Republik Indonesia Nomor 28 Tahun 2021 tentang pedoman penggunaan antibiotik; 2021.

World Health Organization. The WHO AWaRe (Access, Watch, Reserve) antibiotic book. Geneva: World Health Organization; 2022.

Sulis G, Adam P, Nafade V, Gore G, Daniels B, Daftary A. Antibiotic prescription practices in primary care in low and middle-income countries: a systematic review and meta-analysis. PLOS Med. 2020;17(6):e1003139. doi: 10.1371/journal.pmed.1003139, PMID 32544153.

Limato R, Nelwan EJ, Mudia M, De Brabander J, Guterres H, Enty E. A multicentre point prevalence survey of patterns and quality of antibiotic prescribing in Indonesian hospitals. JAC Antimicrob Resist. 2021;3(2):dlab047. doi: 10.1093/jacamr/dlab047, PMID 33937773.

Pasupulati H, Avadhanula V, Mamilla A, Bamini M, Padi SSV. Antibiotic prescribing practices in primary care settings using 2019 WHO AWaRe framework. J Pharm Res Int. 2021;33(37A):58-68. doi: 10.9734/jpri/2021/v33i37A31980.

Budd E, Cramp E, Sharland M, Hand K, Howard P, Wilson P. Adaptation of the WHO essential medicines list for national antibiotic stewardship policy in England: being AWaRe. J Antimicrob Chemother. 2019;74(11):3384-9. doi: 10.1093/jac/dkz321, PMID 31361000.

Rashid MM, Akhtar Z, Chowdhury S, Islam MA, Parveen S, Ghosh PK. Pattern of antibiotic use among hospitalized patients according to WHO Access, Watch, Reserve (AWaRe) classification: findings from a point prevalence survey in Bangladesh. Antibiotics (Basel). 2022;11(6):810. doi: 10.3390/antibiotics11060810, PMID 35740216.

Kementerian Kesehatan RI. Panduan penatagunaan antimikroba di Rumah Sakit. 1st ed. Jakarta: Kementerian Kesehatan RI; 2021.

World Health Organization. Global antimicrobial resistance and use surveillance system (GLASS) report 2022. Geneva: World Health Organization; 2022.

Darwis I, Hidayat H, Wisnu GNPP, Mentari S. Bacteriological profile and antibiotic susceptibility pattern of diabetic foot infection in a tertiary care hospital in Lampung, Indonesia. Malays J Med Sci. 2021;28(5):42-53. doi: 10.21315/mjms2021.28.5.4, PMID 35115886.

Taufik A, Wiweko A, Yudhanto D, Wardoyo EH, Habib P, Rizki M. Bacterial infection and antibiotic resistance pattern in open fracture cases in Indonesia. Ann Med Surg (Lond). 2022;76:103510. doi: 10.1016/j.amsu.2022.103510, PMID 35495387.

World Health Organization. Model List of Essential Medicines. Geneva: World Health Organization; 2023. Available from: https://list.essentialmeds.org. [Last accessed on 22 Sep 2023]

Browne AJ, Chipeta MG, Haines Woodhouse G, Kumaran EPA, Hamadani BHK, Zaraa S. Global antibiotic consumption and usage in humans, 2000-18: a spatial modelling study. Lancet Planet Health. 2021;5(12):e893-904. doi: 10.1016/S2542-5196(21)00280-1, PMID 34774223.

Published

07-05-2024

How to Cite

AGUSTINA AMBARITA, D. S., OKTAMIANTI, P., & TRISNADEWI, I. G. A. (2024). ANTIBIOTICS IN INDONESIA: ACCESS, WATCH, AND RESERVE CLASSIFICATION. International Journal of Applied Pharmaceutics, 16(3), 78–85. https://doi.org/10.22159/ijap.2024v16i3.50351

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Original Article(s)