Limato Ralalicia, Lazarus Gilbert, Dernison Puck, Mudia Manzilina, Alamanda Monik, Nelwan Erni J, Sinto Robert, Karuniawati Anis, Rogier van Doorn H, Hamers Raph L
Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia.
Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
Lancet Reg Health Southeast Asia. 2022 May 26;2:100013. doi: 10.1016/j.lansea.2022.05.002. eCollection 2022 Jul.
A major driver of antimicrobial resistance (AMR) and poor clinical outcomes is suboptimal antibiotic use, although data are lacking in low-resource settings. We reviewed studies on systemic antibiotic use (WHO ATC/DDD category J01) for human health in Indonesia, and synthesized available evidence to identify opportunities for intervention.
We systematically searched five international and national databases for eligible peer-reviewed articles, in English and Indonesian, published between 1 January 2000 and 1 June 2021 including: (1) antibiotic consumption; (2) prescribing appropriateness; (3) antimicrobial stewardship (AMS); (4) consumers' and providers' perceptions. Two independent reviewers included studies and extracted data. Study-level data were summarized using random-effects model meta-analysis for consumption and prescribing appropriateness, effect direction analysis for antimicrobial stewardship (AMS) interventions, and qualitative synthesis for perception surveys. (PROSPERO: CRD42019134641).
Of 9323 search hits, we included 100 reports on antibiotic consumption (20), prescribing appropriateness (49), AMS interventions (13), and/or perception (25) (8 categorized in >1 domain). The pooled estimate of overall antibiotic consumption was 134.8 DDD per 100 bed-days (95%CI 82.5-187.0) for inpatients and 121.1 DDD per 1000 inhabitants per day (10.4-231.8) for outpatients. Ceftriaxone, levofloxacin, and ampicillin were the most consumed antibiotics in inpatients, and amoxicillin, ciprofloxacin, and cefadroxil in outpatients. Pooled estimates for overall appropriate prescribing (according to Gyssens method) were 33.5% (18.1-53.4) in hospitals and 49.4% (23.7-75.4) in primary care. Pooled estimates for appropriate prescribing (according to reference guidelines) were, in hospitals, 99.7% (97.4-100) for indication, 84.9% (38.5-98.0) for drug choice, and 6.1% (0.2-63.2) for overall appropriateness, and, in primary care, 98.9% (60.9-100) for indication, 82.6% (50.5-95.7) for drug choice and 10.5% (0.8-62.6) for overall appropriateness. Studies to date evaluating bundled AMS interventions, although sparse and heterogeneous, suggested favourable effects on antibiotic consumption, prescribing appropriateness, guideline compliance, and patient outcomes. Key themes identified in perception surveys were lack of community antibiotic knowledge, and common non-prescription antibiotic self-medication.
Context-specific intervention strategies are urgently needed to improve appropriate antibiotic use in Indonesian hospitals and communities, with critical evidence gaps concerning the private and informal healthcare sectors.
Wellcome Africa Asia Programme Vietnam.
尽管在资源匮乏地区缺乏相关数据，但抗生素使用不当是导致抗菌药物耐药性（AMR）和不良临床结局的主要原因。我们回顾了印度尼西亚有关人类健康系统使用抗生素（WHO ATC/DDD分类J01）的研究，并综合现有证据以确定干预机会。
我们系统检索了五个国际和国家数据库，以查找2000年1月1日至2021年6月1日期间发表的符合条件的英文和印尼文同行评审文章，包括：（1）抗生素消费；（2）处方适宜性；（3）抗菌药物管理（AMS）；（4）消费者和提供者的认知。两名独立评审员纳入研究并提取数据。使用随机效应模型荟萃分析对消费和处方适宜性进行研究水平数据汇总，对抗菌药物管理（AMS）干预措施进行效应方向分析，对认知调查进行定性综合分析。（国际前瞻性系统评价注册库：CRD42019134641）。
在9323条搜索结果中，我们纳入了100篇关于抗生素消费（20篇）、处方适宜性（49篇）、AMS干预措施（13篇）和/或认知（25篇）的报告（8篇归入多个领域）。住院患者抗生素总体消费量的汇总估计为每100床日134.8限定日剂量（95%CI 82.5 - 187.0），门诊患者为每1000居民每日121.1限定日剂量（10.4 - 231.8）。头孢曲松、左氧氟沙星和氨苄西林是住院患者中消费最多的抗生素，门诊患者中为阿莫西林、环丙沙星和头孢羟氨苄。根据吉森斯方法，医院总体适宜处方的汇总估计为33.5%（18.1 - 53.4），初级保健为49.4%（23.7 - 75.4）。根据参考指南，医院中适应证的适宜处方汇总估计为99.7%（97.4 - 100），药物选择为84.9%（38.5 - 98.0），总体适宜性为6.1%（0.2 - 63.2）；初级保健中适应证为98.9%（60.9 - 100），药物选择为82.6%（50.5 - 95.7），总体适宜性为
