PATTERN OF SELF-MEDICATION WITH ANTIBIOTICS IN DENPASAR CITY, INDONESIA.

PATTERN OF SELF-MEDICATION WITH ANTIBIOTICS

IN DENPASAR CITY, INDONESIA

Jesika Ginotodihardjo1_{, I Gusti Ayu Artini}2

1_{Student of Faculty of Medicine, Udayana University, Bali, Indonesia}

2_{Departement of Pharmacology, Faculty of Medicine, Udayana University, Bali, Indonesia}

Abstract

Introduction: Self-medication with antibiotics that commonly related to misperception and lack of knowledge make antibiotic resistance become hard to control. This study aimed to investigate the prevalence of self-medication with antibiotic as well as knowledge regarding antibiotic usage in Denpasar City, Indonesia. Methods: This cross sectional population based survey directly interviewed respondents using structured questionnaire in Bahasa. A hundred respondents were selected using non probability-convenience sampling method in November-December 2013. The data were analyzed descriptively, and then the proportion data were analyzed using Chi Square. Results:

Forty three percent of respondents did self-medication with antibiotic, and simplicity (43%) is the most popular reason, beside feel confident, cost saving, inaccessibility from health care, time saving, and recommended by others. Pharmacists were the most common source of drug (91%). Gender was found to be statistically significant with p<0.05, whereas age and education level were not significant (p>0.05). Conclusions:

The prevalence of self-medication with antibiotics in this study is quite high, but it needs further investigation to generalize this result to Denpasar population.

Keywords: Antibiotics, Resistance, Self-medication

Abstrak

Pendahuluan: Pengobatan mandiri menggunakan antibiotik yang pada umumnya berkaitan dengan persepsi yang salah dan kurangnya pengetahuan menyebabkan masalah resistensi antibiotik menjadi sulit dikendalikan. Studi ini bertujuan untuk mengetahui prevalensi pengobatan mandiri menggunakan antibiotik dan pengetahuan masyarakat mengenai penggunaan antibiotik di Kota Denpasar, Indonesia. Metode:

Penelitian ini menggunakan metode cross sectional. Responden diwawancara secara langsung menggunakan kuisioner dalam bahasa Indonesia. Seratus responden dipilih menggunakan metode pengambilan sampel non probabilitas-kenyamanan pada bulan November-Desember 2013. Data yang terkumpul dianalis secara deskriptif, dan data proporsi dianalisis menggunakan Chi Square. Hasil: Empat puluh tiga persen dari responden pernah melakukan pengobatan mandiri dengan antibiotik, dan praktis (43%) menjadi alasan terbanyak disamping merasa paham, hemat biaya, kesulitan mengakses layanan kesehatan, hemat waktu, dan direkomendasi oleh oranglain. Apotek menjadi sumber obat-obatan paling umum (91%). Jenis kelamin menunjukkan signifikansi secara statistik dengan p<0.05, sedangkan usia dan tingkat pendidikan tidak signifikan (p>0.05). Kesimpulan: Prevalensi pengobatan mandiri dengan antibiotik pada studi ini cukup tinggi, namun dibutuhkan penelitian lebih lanjut untuk dapat menggambarkan penduduk Denpasar secara umum.

1

PATTERN OF SELF-MEDICATION WITH ANTIBIOTICS

IN DENPASAR CITY, INDONESIA

Jesika Ginotodihardjo1, I Gusti Ayu Artini2 1

Student of Faculty of Medicine, Udayana University, Bali, Indonesia 2

Departement of Pharmacology, Faculty of Medicine, Udayana University, Bali, Indonesia

Abstract

Introduction: Self-medication with antibiotics that commonly related to misperception and lack of knowledge make antibiotic resistance become hard to control. This study aimed to investigate the prevalence of self-medication with antibiotic as well as knowledge regarding antibiotic usage in Denpasar City, Indonesia. Methods: This cross sectional population based survey directly interviewed respondents using structured questionnaire in Bahasa. A hundred respondents were selected using non probability-convenience sampling method in November-December 2013. The data were analyzed descriptively, and then the proportion data were analyzed using Chi Square. Results:

Forty three percent of respondents did self-medication with antibiotic, and simplicity (43%) is the most popular reason, beside feel confident, cost saving, inaccessibility from health care, time saving, and recommended by others. Pharmacists were the most common source of drug (91%). Gender was found to be statistically significant with p<0.05, whereas age and education level were not significant (p>0.05). Conclusions:

The prevalence of self-medication with antibiotics in this study is quite high, but it needs further investigation to generalize this result to Denpasar population.

Keywords: Antibiotics, Resistance, Self-medication

Abstrak

Pendahuluan: Pengobatan mandiri menggunakan antibiotik yang pada umumnya berkaitan dengan persepsi yang salah dan kurangnya pengetahuan menyebabkan masalah resistensi antibiotik menjadi sulit dikendalikan. Studi ini bertujuan untuk mengetahui prevalensi pengobatan mandiri menggunakan antibiotik dan pengetahuan masyarakat mengenai penggunaan antibiotik di Kota Denpasar, Indonesia. Metode:

Penelitian ini menggunakan metode cross sectional. Responden diwawancara secara langsung menggunakan kuisioner dalam bahasa Indonesia. Seratus responden dipilih menggunakan metode pengambilan sampel non probabilitas-kenyamanan pada bulan November-Desember 2013. Data yang terkumpul dianalis secara deskriptif, dan data proporsi dianalisis menggunakan Chi Square. Hasil: Empat puluh tiga persen dari responden pernah melakukan pengobatan mandiri dengan antibiotik, dan praktis (43%) menjadi alasan terbanyak disamping merasa paham, hemat biaya, kesulitan mengakses layanan kesehatan, hemat waktu, dan direkomendasi oleh oranglain. Apotek menjadi sumber obat-obatan paling umum (91%). Jenis kelamin menunjukkan signifikansi secara statistik dengan p<0.05, sedangkan usia dan tingkat pendidikan tidak signifikan (p>0.05). Kesimpulan: Prevalensi pengobatan mandiri dengan antibiotik pada studi ini cukup tinggi, namun dibutuhkan penelitian lebih lanjut untuk dapat menggambarkan penduduk Denpasar secara umum.

2 Introduction

The antibiotic resistance has already become a global problem and therefore

WHO has stated “Antibiotic

Resistance” as the topic in World Health Day on April 7th, 2011. WHO defines the appropriate use of antibiotic as cost effective use which can maximizes clinical therapeutic effect while minimizing both drug related toxicity and the development of antibiotic resistance.1

Many researches have been conducted to identify the prevalence of antibiotic resistance; one of them is penicilin-non-susceptible Streptococcus pneumoniae

(PNSP) in Southeast Asian.

S.pneumoniae as the major pathogen of pneumonia, meningitis, and otitis media in children and adult, had been altered to be penicillin resistance more than 40% PNSP in Singapore (2000), and 21% in Jakarta (1996).2

Many factors contribute to inappropriate use of antibiotics that subsequently lead to resistance; one of them is a patient-related factor including self-medication and poor adherence to dosage regiment.1 Self-medication with antibiotics (SMA) that commonly related to misperception and

lack of knowledge make this resistance become hard to control. The habit of community to use antibiotic inappropriately makes this topic become interesting to be explored further. This study aimed to investigate the prevalence of SMA as well as people’s knowledge regarding their antibiotic usage.

Methods

This descriptive cross sectional study was conducted in Denpasar City on November until December 2013 to assess self-medication with antibiotic as well as respondents’ knowledge about antibiotic. The respondents were selected using non probability-convenient sampling. Respondents included in this study were non-health care provider, age over 17 years old, lived at Denpasar area, and had history of antibiotic usage. Respondents’ habit and knowledge related to antibiotic were directly interviewed using structured questionnaire in Bahasa. The questionnaire was pre-tested to a number of respondents, and resulted in some revisions.

There were 14 questions related to last antibiotic usage, conditions of usage, health seeking behavior, source of

3

antibiotic, and respondents’ knowledge including antibiotic function and target, antibiotic usage immediately after fever, and antibiotic resistance. Demographic information such as date of birth, gender, address, last education achievement, and job were also recorded.

The collected data were stored and analyzed descriptively. Proportion data were analyzed using Chi Square.

Results

Demographic characteristic

Data from 100 respondents who have past history of using antibiotics was successfully collected. Respondents’ age ranged from 18 to 62 years old. Most respondents were female and already passed the senior high school. The complete demographic data were presented in Table 1.

There was no significant difference (p>0.05) in self-medication pattern between younger respondents (<33 years old) with the older ones (≥33 years old), and also between lower education level (elementary, junior high school) with the higher (senior high school and collage). Statistically significant data was found in gender with p<0.05.

Pattern of antibiotic usage

Almost half of respondents were found to do self-medication for their last antibiotic usage with various reasons. As shown in Table 2, most of respondents who did SMA, obtained antibiotic from pharmacy, and the rest got from remaining drugs of past treatment. The types of antibiotic used by respondents were presented in Table 3.

Knowledge of antibiotic

Some figures were presented below regarding respondents’ knowledge about antibiotic usage. Figure 1 shows the respondents’ knowledge about antibiotic function. Most of respondents agreed that antibiotic was used to eradicate the infection. The target of antibiotic also was recorded and presented in Figure 2.

Knowledge about antibiotic resistance and immediate antibiotic usage in fever are presented in Figure 3. Both SMA and non-SMA respondents stated that they have already known that inappropriate use of antibiotic would lead to bacterial resistance. More than half of respondents agreed not to use antibiotic immediately after getting fever.

4

Table 1. Demographic characteristics of respondents

Demographic characteristics SMA

n(%)

Non SMA n(%) Gender

Female 15 (33) 38 (70)

Male 31 (67) 16 (30)

Age in years

< 20 3 (7) 5 (9)

20 – 29 26 (56) 24 (44)

30 – 39 8 (17) 16 (30)

40 – 49 6 (13) 5 (9)

50 – 59 3 (7) 3 (6)

≥ 60 0 (0) 1 (2)

Highest education achievement

Elementary school 2 (4) 5 (9)

Junior high school 3 (7) 5 (9)

Senior high school 30 (65) 36 (67)

Collage 11 (24) 8 (15)

Table 2. Pattern of SMA in respondents

Pattern of SMA n (%)

Reasons

Simplicity 20 (43)

Feel confident 12 (26)

Cost saving 9 (20)

Inaccessibility from health care 3 (7)

Time saving 1 (2)

Recommended by others 1 (2)

Source of antibiotics

Last medication 4 (7)

Pharmacy 42 (91)

Table 3. Type of antibiotic, which were used in SMA

Types of Antibiotic n (%)

Amoxicillin 60 (60)

Unknown 36 (36)

Ciprofloxacin 2 (2)

Cefadroxil 1 (1)

5

Figure 1. Knowledge about antibiotic function among respondents

Figure 2. Knowledge about antibiotic target among respondents

Figure 3. Knowledge about resistance and immediate antibiotic usage in fever

Discussion

Almost half of respondents did self-medication with antibiotics, which most of them bought it in pharmacy without

doctor’s prescription or prior

consultation. Unfortunately, this habit was not supported with appropriate knowledge.

0 20 40 60

SMA non SMA

Percentage of respondents (%)

Ant

ibi

o

tic

fun

ct

io

ns

others pain relieve increase immunity decrease fever eradicate infection

0 20 40 60

SMA non SMA

Percentage of respondents (%)

Ant

ibi

o

tic

ta

rg

et

both viral bacteria

0 20 40 60 80 100 120

antibiotic usage in fever (SMA) antibiotic usage in fever (non SMA) Inappropriate use of antibiotic lead to

resistency (SMA)

Inappropriate use of antibiotic lead to resistency (non SMA)

Percentage of respondents (%)

it

em

s

o

f

k

no

w

ledg

e

Yes No

6

Many studies have been done to evaluate SMA pattern in Indonesia and also in other countries, like China and Sudan.3,4,5 Poverty, lack of information, and poor regulation that related to drug distribution may contribute to self- medication with antibiotics.3 Female, older age, and having higher education were also stated as risk factors.4,5

Actually, antibiotic in Indonesia is

categorized as “obat keras” which

means it could not be accessed easily without doctor’s prescription.3,6,7 The commonly used antibiotics like amoxicillin in developing countries are 10- to 30-folds cheaper than that in the developed countries.8,9 That condition makes antibiotics become more reachable.

Respondents’ previous experiences regarding similar illness increase their confident to do self-medication, and start to ignore the role of doctors.7 Inappropriate use of antibiotic for viral-related illness eradication especially for common cold, which is a self limiting disease, contribute in antibiotic resistance related to self-medication. 6,10-14

Adequate information, expert explanation, and better regulation in

drug distribution should be done to prevent further misperception and inappropriate self-medication especially with antibiotics.

However, this study has some limitations, including inadequate number of respondents and the sampling technique. These would limit the generalization of the study results to Denpasar population. The information given by respondents might potentially result in bias. Further studies with larger number of respondents are suggested to determine the prevalence and factors that potentially affect self-medication with antibiotic in Denpasar, especially for rural area.

Conclusion

The prevalence of self-medication with antibiotic is quite high in Denpasar. Misperception and lack of knowledge appear and result in inappropriate use of antibiotic. Gender as one of demographic characteristics is statistically significant in this study. Further education about antibiotic as well as correction of drug regulation should be done to prevent further antibiotic resistance.

7 References

1. WHO. WHO Global Strategy for Containment of Antimicrobial Resistance. 2001. Available at: http://whqlibdoc.who.int/hq/2001/W HO_CDS_CSR_DRS_2001.2.pdf. Cited in November,21 2013.

2. Lestari ES, Severin JA, Verbrugh HA, Antimicrobial Resistance Among Pathogenic Bacteria in Southeast Asia. Southeast Asian Journal of Tropical Medicine and Public Health. 2012; 43(2): 385-423.

3. Widayati A, Suryawati S, Crespigny C, Hiller JE. Self Medication with Antibiotics in Yogyakarta City Indonesia: A Cross Sectional Population-based Survey. BMC Research Notes. 2011; 4: 491. 4. Pan H, Cui B, Zhang D, Farrar J,

Law F, Thein WB. Prior Knowledge, Older Age, and Higher Allowance are Risk Factors for Self-Medication with Antibiotics among University Students in Southern China. Plos ONE. 2012; 7(7).

5. Awad A. Self-Medication with Antibiotics and Antimalarials in the Community of Khartoum State, Sudan. Journal of Pharmacy

&Pharmaceutical Sciences. 2005; 8(2): 326-331.

6. Undang-Undang Obat Keras.

Direktorat Jendral Pelayanan Kefarmasian dan Alat Kesehatan.

1949. Available at:

http://www.dikti.go.id/files/atur/seh at/UU-419-1949OrdonansiObat Keras.pdf. Cited in November,22 2013.

7. Shojania KG, McDonald KM, Wachter RM, Owens DK. Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies: Antibiotic Prescribing Behavior. 2006; 4(9): 45-48.

8. Abdulah R. Antibitoic Abuse in Developing Countries. Pharma-ceutical Regulatory Affairs. 2012; 1(2).

9. Hadi U, Duerink DO, Lestari ES, Nagelkerke NJ, Werter S, Keuter M, Suswandojo E, Rahardjo E, Broek P, Gyssens IC. Survey of Antibiotic Use of Individuals Visiting Public Healthcare Facilities in Indonesia.

International Journal of Infectious Diseases. 2008; 12: 622-629.

10.Widayati A, Suryawati S, Crespigny C, Hiller JE. Knowledge and Beliefs about Antibiotics among People in Yogyakarta City Indonesia: A Cross

8

Sectional Population-based Survey.

Antimicrobial Resistance and Infection Control. 2012; 1:38. 11.Mohanna M. Self-Medication with

Antibiotic in Children in Sana’a City, Yemen. Oman Medical Journal. 2010; 25: 41-43.

12.Aditya S, Rattan A. Self-Medication among Dental Undergraduate Students with Antibiotics: Looking beyond The Known. Asian Journal of Pharmaceutical and Clinical Research. 2013; 6(4).

13.Osemene KP, Lamikanra A. A Study of The Prevalence of Self-Medication Practice among University Students in South-western Nigeria. Tropical Journal of Pharmaceutical Research. 2012; 11: 683-689.

14.Grigoryan L, Ruskamp FMH, Burgerhof JGM, Mechtler R, Deschepper R, Andrasevic AT, Andrahati R, Monnet DL, Cunney R, Matteo AD, Edelstein H, Valinteliene R, Alkerwi A, Scicluna EA, Grzesiowski P, Bara AC, Tesar T, Cizman M, Campos J, Lundborg CS, Birkin J. Self-Medication with Anti-microbial Drugs in Europe.

Emerging Infectious Diseases. 2006; 12(3): 452-459.

1

PATTERN OF SELF-MEDICATION WITH ANTIBIOTICS

IN DENPASAR CITY, INDONESIA

Jesika Ginotodihardjo1, I Gusti Ayu Artini2 1

Student of Faculty of Medicine, Udayana University, Bali, Indonesia 2

Departement of Pharmacology, Faculty of Medicine, Udayana University, Bali, Indonesia

Abstract

Introduction: Self-medication with antibiotics that commonly related to misperception and lack of knowledge make antibiotic resistance become hard to control. This study aimed to investigate the prevalence of self-medication with antibiotic as well as knowledge regarding antibiotic usage in Denpasar City, Indonesia. Methods: This cross sectional population based survey directly interviewed respondents using structured questionnaire in Bahasa. A hundred respondents were selected using non probability-convenience sampling method in November-December 2013. The data were analyzed descriptively, and then the proportion data were analyzed using Chi Square. Results:

Forty three percent of respondents did self-medication with antibiotic, and simplicity (43%) is the most popular reason, beside feel confident, cost saving, inaccessibility from health care, time saving, and recommended by others. Pharmacists were the most common source of drug (91%). Gender was found to be statistically significant with p<0.05, whereas age and education level were not significant (p>0.05). Conclusions:

The prevalence of self-medication with antibiotics in this study is quite high, but it needs further investigation to generalize this result to Denpasar population.

Keywords: Antibiotics, Resistance, Self-medication

Abstrak

Pendahuluan: Pengobatan mandiri menggunakan antibiotik yang pada umumnya berkaitan dengan persepsi yang salah dan kurangnya pengetahuan menyebabkan masalah resistensi antibiotik menjadi sulit dikendalikan. Studi ini bertujuan untuk mengetahui prevalensi pengobatan mandiri menggunakan antibiotik dan pengetahuan masyarakat mengenai penggunaan antibiotik di Kota Denpasar, Indonesia. Metode:

Penelitian ini menggunakan metode cross sectional. Responden diwawancara secara langsung menggunakan kuisioner dalam bahasa Indonesia. Seratus responden dipilih menggunakan metode pengambilan sampel non probabilitas-kenyamanan pada bulan November-Desember 2013. Data yang terkumpul dianalis secara deskriptif, dan data proporsi dianalisis menggunakan Chi Square. Hasil: Empat puluh tiga persen dari responden pernah melakukan pengobatan mandiri dengan antibiotik, dan praktis (43%) menjadi alasan terbanyak disamping merasa paham, hemat biaya, kesulitan mengakses layanan kesehatan, hemat waktu, dan direkomendasi oleh oranglain. Apotek menjadi sumber obat-obatan paling umum (91%). Jenis kelamin menunjukkan signifikansi secara statistik dengan p<0.05, sedangkan usia dan tingkat pendidikan tidak signifikan (p>0.05). Kesimpulan: Prevalensi pengobatan mandiri dengan antibiotik pada studi ini cukup tinggi, namun dibutuhkan penelitian lebih lanjut untuk dapat menggambarkan penduduk Denpasar secara umum.

2 Introduction

The antibiotic resistance has already become a global problem and therefore

WHO has stated “Antibiotic

Resistance” as the topic in World Health Day on April 7th, 2011. WHO defines the appropriate use of antibiotic as cost effective use which can maximizes clinical therapeutic effect while minimizing both drug related toxicity and the development of antibiotic resistance.1

Many researches have been conducted to identify the prevalence of antibiotic resistance; one of them is penicilin-non-susceptible Streptococcus pneumoniae

(PNSP) in Southeast Asian.

S.pneumoniae as the major pathogen of pneumonia, meningitis, and otitis media in children and adult, had been altered to be penicillin resistance more than 40% PNSP in Singapore (2000), and 21% in Jakarta (1996).2

Many factors contribute to inappropriate use of antibiotics that subsequently lead to resistance; one of them is a patient-related factor including self-medication and poor adherence to dosage regiment.1 Self-medication with antibiotics (SMA) that commonly related to misperception and

lack of knowledge make this resistance become hard to control. The habit of community to use antibiotic inappropriately makes this topic become interesting to be explored further. This study aimed to investigate the prevalence of SMA as well as people’s knowledge regarding their antibiotic usage.

Methods

This descriptive cross sectional study was conducted in Denpasar City on November until December 2013 to assess self-medication with antibiotic as well as respondents’ knowledge about antibiotic. The respondents were selected using non probability-convenient sampling. Respondents included in this study were non-health care provider, age over 17 years old, lived at Denpasar area, and had history of antibiotic usage. Respondents’ habit and knowledge related to antibiotic were directly interviewed using structured questionnaire in Bahasa. The questionnaire was pre-tested to a number of respondents, and resulted in some revisions.

There were 14 questions related to last antibiotic usage, conditions of usage, health seeking behavior, source of

3

antibiotic, and respondents’ knowledge including antibiotic function and target, antibiotic usage immediately after fever, and antibiotic resistance. Demographic information such as date of birth, gender, address, last education achievement, and job were also recorded.

The collected data were stored and analyzed descriptively. Proportion data were analyzed using Chi Square.

Results

Demographic characteristic

Data from 100 respondents who have past history of using antibiotics was successfully collected. Respondents’ age ranged from 18 to 62 years old. Most respondents were female and already passed the senior high school. The complete demographic data were presented in Table 1.

There was no significant difference (p>0.05) in self-medication pattern between younger respondents (<33 years old) with the older ones (≥33 years old), and also between lower education level (elementary, junior high school) with the higher (senior high school and collage). Statistically significant data was found in gender with p<0.05.

Pattern of antibiotic usage

Almost half of respondents were found to do self-medication for their last antibiotic usage with various reasons. As shown in Table 2, most of respondents who did SMA, obtained antibiotic from pharmacy, and the rest got from remaining drugs of past treatment. The types of antibiotic used by respondents were presented in Table 3.

Knowledge of antibiotic

Some figures were presented below regarding respondents’ knowledge about antibiotic usage. Figure 1 shows the respondents’ knowledge about antibiotic function. Most of respondents agreed that antibiotic was used to eradicate the infection. The target of antibiotic also was recorded and presented in Figure 2.

Knowledge about antibiotic resistance and immediate antibiotic usage in fever are presented in Figure 3. Both SMA and non-SMA respondents stated that they have already known that inappropriate use of antibiotic would lead to bacterial resistance. More than half of respondents agreed not to use antibiotic immediately after getting fever.

4

Table 1. Demographic characteristics of respondents

Demographic characteristics SMA

n(%)

Non SMA n(%) Gender

Female 15 (33) 38 (70)

Male 31 (67) 16 (30)

Age in years

< 20 3 (7) 5 (9)

20 – 29 26 (56) 24 (44)

30 – 39 8 (17) 16 (30)

40 – 49 6 (13) 5 (9)

50 – 59 3 (7) 3 (6)

≥ 60 0 (0) 1 (2)

Highest education achievement

Elementary school 2 (4) 5 (9)

Junior high school 3 (7) 5 (9)

Senior high school 30 (65) 36 (67)

Collage 11 (24) 8 (15)

Table 2. Pattern of SMA in respondents

Pattern of SMA n (%)

Reasons

Simplicity 20 (43)

Feel confident 12 (26)

Cost saving 9 (20)

Inaccessibility from health care 3 (7)

Time saving 1 (2)

Recommended by others 1 (2)

Source of antibiotics

Last medication 4 (7)

Pharmacy 42 (91)

Table 3. Type of antibiotic, which were used in SMA

Types of Antibiotic n (%)

Amoxicillin 60 (60)

Unknown 36 (36)

Ciprofloxacin 2 (2)

Cefadroxil 1 (1)

5

Figure 1. Knowledge about antibiotic function among respondents

Figure 2. Knowledge about antibiotic target among respondents

Figure 3. Knowledge about resistance and immediate antibiotic usage in fever

Discussion

Almost half of respondents did self-medication with antibiotics, which most of them bought it in pharmacy without

doctor’s prescription or prior

consultation. Unfortunately, this habit was not supported with appropriate knowledge.

0 20 40 60

SMA non SMA

Percentage of respondents (%)

Ant

ibi

o

tic

fun

ct

io

ns

others pain relieve increase immunity decrease fever eradicate infection

0 20 40 60

SMA non SMA

Percentage of respondents (%)

Ant

ibi

o

tic

ta

rg

et

both viral bacteria

0 20 40 60 80 100 120

antibiotic usage in fever (SMA) antibiotic usage in fever (non SMA) Inappropriate use of antibiotic lead to

resistency (SMA)

Inappropriate use of antibiotic lead to resistency (non SMA)

Percentage of respondents (%)

it

em

s

o

f

k

no

w

ledg

e

Yes No

6

Many studies have been done to evaluate SMA pattern in Indonesia and also in other countries, like China and Sudan.3,4,5 Poverty, lack of information, and poor regulation that related to drug distribution may contribute to self- medication with antibiotics.3 Female, older age, and having higher education were also stated as risk factors.4,5

Actually, antibiotic in Indonesia is

categorized as “obat keras” which

means it could not be accessed easily without doctor’s prescription.3,6,7 The commonly used antibiotics like amoxicillin in developing countries are 10- to 30-folds cheaper than that in the developed countries.8,9 That condition makes antibiotics become more reachable.

Respondents’ previous experiences regarding similar illness increase their confident to do self-medication, and start to ignore the role of doctors.7 Inappropriate use of antibiotic for viral-related illness eradication especially for common cold, which is a self limiting disease, contribute in antibiotic resistance related to self-medication. 6,10-14

Adequate information, expert explanation, and better regulation in

drug distribution should be done to prevent further misperception and inappropriate self-medication especially with antibiotics.

However, this study has some limitations, including inadequate number of respondents and the sampling technique. These would limit the generalization of the study results to Denpasar population. The information given by respondents might potentially result in bias. Further studies with larger number of respondents are suggested to determine the prevalence and factors that potentially affect self-medication with antibiotic in Denpasar, especially for rural area.

Conclusion

The prevalence of self-medication with antibiotic is quite high in Denpasar. Misperception and lack of knowledge appear and result in inappropriate use of antibiotic. Gender as one of demographic characteristics is statistically significant in this study. Further education about antibiotic as well as correction of drug regulation should be done to prevent further antibiotic resistance.

7 References

1. WHO. WHO Global Strategy for Containment of Antimicrobial Resistance. 2001. Available at: http://whqlibdoc.who.int/hq/2001/W HO_CDS_CSR_DRS_2001.2.pdf. Cited in November,21 2013.

2. Lestari ES, Severin JA, Verbrugh HA, Antimicrobial Resistance Among Pathogenic Bacteria in Southeast Asia. Southeast Asian Journal of Tropical Medicine and Public Health. 2012; 43(2): 385-423.

3. Widayati A, Suryawati S, Crespigny C, Hiller JE. Self Medication with Antibiotics in Yogyakarta City Indonesia: A Cross Sectional Population-based Survey. BMC Research Notes. 2011; 4: 491. 4. Pan H, Cui B, Zhang D, Farrar J,

Law F, Thein WB. Prior Knowledge, Older Age, and Higher Allowance are Risk Factors for Self-Medication with Antibiotics among University Students in Southern China. Plos ONE. 2012; 7(7).

5. Awad A. Self-Medication with Antibiotics and Antimalarials in the Community of Khartoum State, Sudan. Journal of Pharmacy

&Pharmaceutical Sciences. 2005; 8(2): 326-331.

6. Undang-Undang Obat Keras.

Direktorat Jendral Pelayanan Kefarmasian dan Alat Kesehatan.

1949. Available at:

http://www.dikti.go.id/files/atur/seh at/UU-419-1949OrdonansiObat Keras.pdf. Cited in November,22 2013.

7. Shojania KG, McDonald KM, Wachter RM, Owens DK. Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies: Antibiotic Prescribing Behavior. 2006; 4(9): 45-48.

8. Abdulah R. Antibitoic Abuse in Developing Countries. Pharma-ceutical Regulatory Affairs. 2012; 1(2).

9. Hadi U, Duerink DO, Lestari ES, Nagelkerke NJ, Werter S, Keuter M, Suswandojo E, Rahardjo E, Broek P, Gyssens IC. Survey of Antibiotic Use of Individuals Visiting Public Healthcare Facilities in Indonesia.

International Journal of Infectious Diseases. 2008; 12: 622-629.

10.Widayati A, Suryawati S, Crespigny C, Hiller JE. Knowledge and Beliefs about Antibiotics among People in Yogyakarta City Indonesia: A Cross

8

Sectional Population-based Survey.

Antimicrobial Resistance and Infection Control. 2012; 1:38. 11.Mohanna M. Self-Medication with

Antibiotic in Children in Sana’a City, Yemen. Oman Medical Journal. 2010; 25: 41-43.

12.Aditya S, Rattan A. Self-Medication among Dental Undergraduate Students with Antibiotics: Looking beyond The Known. Asian Journal of Pharmaceutical and Clinical Research. 2013; 6(4).

13.Osemene KP, Lamikanra A. A Study of The Prevalence of Self-Medication Practice among University Students in South-western Nigeria. Tropical Journal of Pharmaceutical Research. 2012; 11: 683-689.

14.Grigoryan L, Ruskamp FMH, Burgerhof JGM, Mechtler R, Deschepper R, Andrasevic AT, Andrahati R, Monnet DL, Cunney R, Matteo AD, Edelstein H, Valinteliene R, Alkerwi A, Scicluna EA, Grzesiowski P, Bara AC, Tesar T, Cizman M, Campos J, Lundborg CS, Birkin J. Self-Medication with Anti-microbial Drugs in Europe.

Emerging Infectious Diseases. 2006; 12(3): 452-459.

3

antibiotic, and respondents’ knowledge including antibiotic function and target, antibiotic usage immediately after fever, and antibiotic resistance. Demographic information such as date of birth, gender, address, last education achievement, and job were also recorded.

The collected data were stored and analyzed descriptively. Proportion data were analyzed using Chi Square. Results

Demographic characteristic

Data from 100 respondents who have past history of using antibiotics was successfully collected. Respondents’ age ranged from 18 to 62 years old. Most respondents were female and already passed the senior high school. The complete demographic data were presented in Table 1.

There was no significant difference (p>0.05) in self-medication pattern between younger respondents (<33 years old) with the older ones (≥33 years old), and also between lower education level (elementary, junior high school) with the higher (senior high school and collage). Statistically significant data was found in gender with p<0.05.

Pattern of antibiotic usage

Almost half of respondents were found to do self-medication for their last antibiotic usage with various reasons. As shown in Table 2, most of respondents who did SMA, obtained antibiotic from pharmacy, and the rest got from remaining drugs of past treatment. The types of antibiotic used by respondents were presented in Table 3.

Knowledge of antibiotic

Some figures were presented below regarding respondents’ knowledge about antibiotic usage. Figure 1 shows the respondents’ knowledge about antibiotic function. Most of respondents agreed that antibiotic was used to eradicate the infection. The target of antibiotic also was recorded and presented in Figure 2.

Knowledge about antibiotic resistance and immediate antibiotic usage in fever are presented in Figure 3. Both SMA and non-SMA respondents stated that they have already known that inappropriate use of antibiotic would lead to bacterial resistance. More than half of respondents agreed not to use antibiotic immediately after getting fever.

4

Table 1. Demographic characteristics of respondents

Demographic characteristics SMA n(%)

Non SMA n(%) Gender

Female 15 (33) 38 (70)

Male 31 (67) 16 (30)

Age in years

< 20 3 (7) 5 (9)

20 – 29 26 (56) 24 (44)

30 – 39 8 (17) 16 (30)

40 – 49 6 (13) 5 (9)

50 – 59 3 (7) 3 (6)

≥ 60 0 (0) 1 (2)

Highest education achievement

Elementary school 2 (4) 5 (9)

Junior high school 3 (7) 5 (9)

Senior high school 30 (65) 36 (67)

Collage 11 (24) 8 (15)

Table 2. Pattern of SMA in respondents

Pattern of SMA n (%)

Reasons

Simplicity 20 (43)

Feel confident 12 (26)

Cost saving 9 (20)

Inaccessibility from health care 3 (7)

Time saving 1 (2)

Recommended by others 1 (2)

Source of antibiotics

Last medication 4 (7)

Pharmacy 42 (91)

Table 3. Type of antibiotic, which were used in SMA

Types of Antibiotic n (%)

Amoxicillin 60 (60)

Unknown 36 (36)

Ciprofloxacin 2 (2)

Cefadroxil 1 (1)

5

Figure 1. Knowledge about antibiotic function among respondents

Figure 2. Knowledge about antibiotic target among respondents

Figure 3. Knowledge about resistance and immediate antibiotic usage in fever

Discussion

Almost half of respondents did self-medication with antibiotics, which most of them bought it in pharmacy without

doctor’s prescription or prior consultation. Unfortunately, this habit was not supported with appropriate knowledge.

0 20 40 60

SMA non SMA

Percentage of respondents (%)

Ant

ibi

o

tic

fun

ct

io

ns

others pain relieve increase immunity decrease fever eradicate infection

0 20 40 60

SMA non SMA

Percentage of respondents (%)

Ant

ibi

o

tic

ta

rg

et

both viral bacteria

0 20 40 60 80 100 120

antibiotic usage in fever (SMA) antibiotic usage in fever (non SMA) Inappropriate use of antibiotic lead to

resistency (SMA)

Inappropriate use of antibiotic lead to resistency (non SMA)

Percentage of respondents (%)

it

em

s

o

f

k

no

w

ledg

e

Yes No

6

Many studies have been done to evaluate SMA pattern in Indonesia and also in other countries, like China and Sudan.3,4,5 Poverty, lack of information, and poor regulation that related to drug distribution may contribute to self- medication with antibiotics.3 Female, older age, and having higher education were also stated as risk factors.4,5

Actually, antibiotic in Indonesia is

categorized as “obat keras” which

means it could not be accessed easily without doctor’s prescription.3,6,7 The commonly used antibiotics like amoxicillin in developing countries are 10- to 30-folds cheaper than that in the developed countries.8,9 That condition makes antibiotics become more reachable.

Respondents’ previous experiences regarding similar illness increase their confident to do self-medication, and start to ignore the role of doctors.7 Inappropriate use of antibiotic for viral-related illness eradication especially for common cold, which is a self limiting disease, contribute in antibiotic resistance related to self-medication. 6,10-14

Adequate information, expert

explanation, and better regulation in

drug distribution should be done to prevent further misperception and inappropriate self-medication especially with antibiotics.

However, this study has some limitations, including inadequate number of respondents and the sampling technique. These would limit the generalization of the study results to Denpasar population. The information given by respondents might potentially result in bias. Further studies with larger number of respondents are suggested to determine the prevalence and factors that potentially affect self-medication with antibiotic in Denpasar, especially for rural area.

Conclusion

The prevalence of self-medication with antibiotic is quite high in Denpasar. Misperception and lack of knowledge appear and result in inappropriate use of antibiotic. Gender as one of demographic characteristics is statistically significant in this study. Further education about antibiotic as well as correction of drug regulation should be done to prevent further antibiotic resistance.

7 References

1. WHO. WHO Global Strategy for Containment of Antimicrobial Resistance. 2001. Available at: http://whqlibdoc.who.int/hq/2001/W HO_CDS_CSR_DRS_2001.2.pdf. Cited in November,21 2013.

2. Lestari ES, Severin JA, Verbrugh HA, Antimicrobial Resistance Among Pathogenic Bacteria in Southeast Asia. Southeast Asian Journal of Tropical Medicine and Public Health. 2012; 43(2): 385-423.

3. Widayati A, Suryawati S, Crespigny C, Hiller JE. Self Medication with Antibiotics in Yogyakarta City Indonesia: A Cross Sectional Population-based Survey. BMC Research Notes. 2011; 4: 491. 4. Pan H, Cui B, Zhang D, Farrar J,

Law F, Thein WB. Prior

Knowledge, Older Age, and Higher Allowance are Risk Factors for Self-Medication with Antibiotics among University Students in Southern China. Plos ONE. 2012; 7(7).

5. Awad A. Self-Medication with Antibiotics and Antimalarials in the Community of Khartoum State, Sudan. Journal of Pharmacy

&Pharmaceutical Sciences. 2005; 8(2): 326-331.

6. Undang-Undang Obat Keras.

Direktorat Jendral Pelayanan Kefarmasian dan Alat Kesehatan.

1949. Available at:

http://www.dikti.go.id/files/atur/seh at/UU-419-1949OrdonansiObat Keras.pdf. Cited in November,22 2013.

7. Shojania KG, McDonald KM, Wachter RM, Owens DK. Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies: Antibiotic Prescribing Behavior. 2006; 4(9): 45-48.

8. Abdulah R. Antibitoic Abuse in Developing Countries. Pharma-ceutical Regulatory Affairs. 2012; 1(2).

9. Hadi U, Duerink DO, Lestari ES, Nagelkerke NJ, Werter S, Keuter M, Suswandojo E, Rahardjo E, Broek P, Gyssens IC. Survey of Antibiotic Use of Individuals Visiting Public Healthcare Facilities in Indonesia. International Journal of Infectious Diseases. 2008; 12: 622-629.

10.Widayati A, Suryawati S, Crespigny C, Hiller JE. Knowledge and Beliefs about Antibiotics among People in Yogyakarta City Indonesia: A Cross

8

Sectional Population-based Survey. Antimicrobial Resistance and Infection Control. 2012; 1:38. 11.Mohanna M. Self-Medication with

Antibiotic in Children in Sana’a

City, Yemen. Oman Medical Journal. 2010; 25: 41-43.

12.Aditya S, Rattan A. Self-Medication among Dental Undergraduate Students with Antibiotics: Looking beyond The Known. Asian Journal of Pharmaceutical and Clinical Research. 2013; 6(4).

13.Osemene KP, Lamikanra A. A Study of The Prevalence of

Self-Medication Practice among

University Students in South-western Nigeria. Tropical Journal of Pharmaceutical Research. 2012; 11: 683-689.

14.Grigoryan L, Ruskamp FMH, Burgerhof JGM, Mechtler R, Deschepper R, Andrasevic AT, Andrahati R, Monnet DL, Cunney R, Matteo AD, Edelstein H, Valinteliene R, Alkerwi A, Scicluna EA, Grzesiowski P, Bara AC, Tesar T, Cizman M, Campos J, Lundborg CS, Birkin J. Self-Medication with Anti-microbial Drugs in Europe. Emerging Infectious Diseases. 2006; 12(3): 452-459.