Jakarta Globe, Dessy Sagita, April 27, 2011
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| A woman being examined by a doctor in Sukabumi, West Java. Health experts say physicians in Indonesia are too quick to prescribe antibiotics unnecessarily for mild ailments such as common colds. (Antara Photo) |
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Hadalya, a 32-year-old housewife, puts a lot of faith in antibiotics, believing they can help her recover faster from any disease.
“I get upset if I go and see a doctor and they don’t prescribe me an antibiotic,” she says. “In that case, I usually just buy 10 amoxicillin capsules from the nearest drugstore.”
The growing trend of Indonesians routinely taking antibiotics prescribed by doctors even for conditions not including infections — or just as frequently bought without a prescription — has raised concerns among health officials about the misuse of the drugs and subsequent rise of drug-resistant bacteria.
This month, the Health Ministry said it was preparing a draft bill aimed at curbing overuse of antibiotics.
A ministry data sheet citing the World Health Organization said there were 440,000 new cases of multidrug-resistant tuberculosis around the world each year, causing at least 150,000 deaths.
Indonesia ranks eighth out of 27 countries suffering from the highest rates of this kind of tuberculosis, according to the WHO.
Nani Sukasediati, an official with the WHO’s Indonesian office, says antibiotic resistance can also be attributed to underuse of the drugs.
“Some patients take excessive amount of antibiotics, while others don’t finish the course of the medication as prescribed by the doctor because they believe they’ve recovered,” she says.
In both cases, Nani continues, the patients will likely require increasingly larger doses or more potent antibiotics the next time they come down with a bacterial infection.
Nani says it is common in Indonesia for patients suffering from diarrhea to be prescribed antibiotics. The WHO estimates that about 65 percent of Indonesian hospitals prescribe antibiotics for such patients.
“When you have diarrhea, your body will try to dispose all toxins, so the best cure is salt and sugar to replace the lost minerals,” she says.
“Antibiotics will only make the recovery process even slower. Self-limiting diseases that go away by themselves don’t require antibiotics.”
She adds those that do were the more serious ones such as tuberculosis and typhoid fever.
Iwan Dwiprahasto, head of the Association of Indonesian Pharmacologists (Ikafi), says patients should ask their doctors about whether their particular medical condition warrants the use of antibiotics before accepting a prescription.
“A common cold that lasts for a few days doesn’t require antibiotics,” he says.
“If you’re only suffering from a runny nose, cough or sore throat, most likely you don’t need it.”
Iwan says taking antibiotics unnecessarily can kill the microorganisms in the colon that serve to break down food waste.
“If those microorganisms are damaged by antibiotics, they can turn into pathogen bacteria that could endanger the body,” he says.
He also cautions against prescribing antibiotics for children below the age of 5, which he says can result in them falling sick more often.
However, Marius Widjajarta, chairman of the Indonesian Consumer Foundation for Health (YPPKI), says the growing problem of antibiotic misuse should not be blamed solely on doctors for prescribing them.
“The government has obviously failed to perform in terms of regulating sales of the drug,” he says.
“People who have no competence can sell antibiotics anywhere they want.”
He adds the government should also monitor nurses, midwives and other health workers who are not allowed to prescribe antibiotics but do anyways.
“The regulations are clear: those who have no business selling antibiotics should be jailed if they do so, and the same goes for doctors who force their patients to take antibiotics when they don’t need it,” he says.
But for patients like Hadalya, these kinds of restrictions are meaningless.
She says she sometimes doesn’t bother going to a doctor if she believes she is suffering from a common cold, and instead goes and buys the antibiotics directly.
“They’re available everywhere, not just in drugstores,” she says.
“Sometimes I also go to my neighbor, who work as a nurse and midwife, and she can also provide me with the drug.”
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