Inappropriate use of antibiotics in the treatment of acute respiratory infections for the underfive children among general practitioners.

Acute respiratory infection (ARI) is the commonest illness in children and the leading cause of morbidity and mortality in many developing countries. It comprises approximately 50% of all illness in children under five years. Unfortunately, most children are commonly treated inappropriately. A population based study involving all general practitioners (GPs) and pharmacies in Yogyakarta Special Province was carried out in June-July 1992 to provide data on antibiotic utilization for acute respiratory infection (ARI). One hundred and ninety one out of 207 GPs and all pharmacies participated in the study by completing structured form distributed during the study. Ninety three percent of patients with ARI seen by GPs were given antibiotic. Based on WHO criteria on ARI, only 7-14% of all patients were eligible to be given antibiotics. The most frequently used antibiotics for the underfives were ampicillin (38.8%) followed by cotrimoxazole (29.2%), amoxycillin (14.9%), and erythromycin (6.13%). Sixty three per cent of drug cost prescribed for the underfives children were accounted for by antibiotics. It can be concluded that inappropriate use of antibiotics was found in more than 75% patients under 5 years of age. In addition to poor indication for antibiotic use inappropriateness was also found in terms of dose, the length of antibiotic use, drug administration, and drug dosage form. Key words: ARI - innapropriate use of antibiotics - underfive children - general practitioners - prescribing pattern Infeksi saluran pernafasan akut (ISPA) merupakan salah satu penyakit yang paling sering diderita dan menjadi penyebab utama kematian pada anak di negara sedang berkembang. Namun demikian hampir sebagian besar penderita ternyata diterapi secara tidak adekuat. Suatu studi cross-sectional telah dilakukan untuk melihat pola peresepan untuk ISPA, dengan melibatkan seluruh dokter umum dan apotek yang berada di Provinsi DIY, antara bulan Juni hingga Juli 1992. Seratus sembilan puluh satu dokter umum (dari total 207) dan seluruh apotek bersedia untuk ikut serta dalam penelitian. Dokter diminta untuk menulis identitas penderita ISPA pada formulir yang telah disediakan. Berdasarkan formulir tersebut dilacak pola peresepan masing-masing melalui penelusuran resep di apotek-apotek. Antibiotika ternyata diresepkan pada 93% pasien dengan ISPA. Berdasarkan kriteriia WHO untuk ISPA, ditemukan bahwa hanya 7-14% pasien yang seharusnya mendapat antibiotika. Antibiotika yang paling sering diresepkan berturut-turut antara lain adalah ampisilin (38%), kotrimoksazol (29,2%), amoksisilin (14,9%), dan eritromisin (6,13%). Dafi segi biaya, 63% biaya obat untuk ISPA digunakan untuk antibiotika. Studi ini menyimpulkan bahwa lebih dari 75% peresepan untuk balita tergolong tidak rasional. Di samping tidak jelasnya indikasi pemakaian antibiotika, dosis, cara pemberian, frekuensi dan lama pemberian ternyata juga tidak tepat