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majority of doctors in Indonesia often prescribe antibiotics to patients even when they do not actually need them — a practice known to trigger antimicrobial resistance (AMR) in the body.

Doctors are often worried that patients have infections caused by bacteria and thus prescribe antibiotics. Sometimes, it is the patients who force the doctors to give them antibiotics as they think they will not recover without it.

According to research by the Antimicrobial Resistance Control Committee (KPRA) at the Health Ministry, more than 50 percent of antibiotic prescriptions from doctors are unnecessary.

“There are lots of illnesses that do not need antibiotics, such as a cough, flu, mild diarrhea and minor cuts. Therefore, people’s understanding of the role of antibiotics needs to be increased,” Harry Parathon, head of the KPRA, told The Jakarta Post.

He also cited a study conducted by the Indonesian Caring Parents Foundation (YOP) involving 92 doctors in Jakarta and 35 doctors in Papua. According to the study, 91 percent of the doctors always prescribed antibiotics to their patients, while 75 percent prescribed antibiotics for mild illnesses like cough and flu, indicating unrestrained use.

Another study by the Health Ministry in 2013 showed that only 27 percent of doctors in Indonesia were prescribing the right doses of antibiotics and for the right purposes.

Therefore, Health Minister Nila F. Moeloek has called on all doctors to refrain from abusing antibiotics.

“I’m asking for help from the Indonesian Doctors Association [IDI] because it’s the behavior of its members [that is in question]. So, please remind all doctors so we can avoid facing disaster again,” she said.

The widespread practice of prescribing antibiotics has led to a rise in AMR in the country. The term describes the ability of a microorganism (like bacteria, viruses or parasites) to stop an antimicrobial (such as antibiotics, antivirals and antimalarials) from working against it.

As a result, standard medical treatments become ineffective and infections persist and are more likely to spread to others. Resistance to current antimicrobials is increasing faster than the development of new drugs, and so effective treatments cannot keep pace.

In Indonesia, doctors are already having to prescribe new types of antibiotics or higher dosages of the same antibiotics because bacteria are getting stronger.

The World Health Organization (WHO) describes AMR as a looming crisis in which common and treatable infections will become life threatening.

“We are predicting that AMR could lead to 10 million deaths per year by 2050 if we do nothing, and cost US$100 trillion to [combat],” Harry said.

Besides from doctors, it is also easy for people to get antibiotics from pharmacies without prescription.

According to the YOP survey, 85 percent of pharmacies in Jakarta sell such drugs without prescriptions. Furthermore, 83 percent of them suggest that customers buy antibiotics, even when a customer only asks for drugs for a mild ailment, such as cough and flu.

The easy access to antibiotics in Indonesia is also shown by ministry research from 2013 that found that 10 percent of families had antibiotics in their homes. At least 86.1 percent of those obtained the drug without a prescription.

Furthermore, many people also fail to take antibiotics in the right dosage.

“In my house, there has to be some antibiotics in the cupboard. That’s one of the indicators that we are not disciplined in using antibiotics,” Nila said.

To combat the rampant abuse of antibiotics in the county and the rise of AMR, the Health Ministry, together with the WHO, is currently drafting a national action plan, scheduled to be finished by next year.

The national action plan will dictate a nationwide effort to reduce the abuse of antibiotics in humans, animals and plants, as antibiotics are also often misused for the treatment and prevention of diseases in livestock, aquaculture and during crop production.

“There are lots of farmers who do not realize that they’re using antibiotics, not only in feed, but also in the livestock’s drinks,” said Andi Hendra Purnama, who is in charge of animal feed at the Agriculture Ministry.

According to him, some antibiotics use “feed additive” labeling, and thus some farmers unknowingly give antibiotics to their livestock.

With the national action plan, the government will invite all stakeholders to combat the rise of AMR.

“It will be hard to battle AMR if the public is not aware of this or is unwilling to change their mindsets. Everyone has to be involved, from the Health Ministry, the Agriculture Ministry and the IDI to pharmacies,” Nila said.
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