Research Article

The Effort to Rationalize Antibiotic Use in Indonesian Hospitals: Practice and Its Implication

Table 4

Clinicians’ compliance with guidelines for the use and restriction of antibiotics and antibiotic sensitivity tests and link to AMR-CP team performance in 10 hospitals, 2018.

No.Hospital nameClinicians’ complianceAMR-CP team performance
Guidelines for use of antibiotics and restriction of antibioticsAntibiotic sensitivity test results

1AAA hospitalCompliance was quite good because it is part of the hospital accreditation assessmentClinicians sometimes did not use the antibiotics test results, and they often did not ask for a sensitivity testIn general, there is a decrease in the use of antibiotics, although the hospital has not explicitly evaluated the performance of the AMR-CP. Good hospital compliance due to accreditation requirement, but sustainability needs to be improved. This can be seen from the fact that clinicians rarely ask for antibiotics sensitivity tests. However, the impact of SOP on antimicrobial resistance can still be seen in reducing the use of antibiotics
2BBB hospitalClinicians’ adherence to antibiotic use guidelines was goodClinicians’ compliance with sensitivity test results because it is in line with NHS treatment guidelinesImprovements in the result of sensitivity pattern based on Geysen qualitative analyses
3CCC hospitalClinician compliance is about 50% with the antimicrobials’ guidelines and SOPs, but clinicians are quite obedient to clinical practice guidelines and pathwaysClinicians have started to comply with the use of antibiotics by considering the culture resultsWork performance has never been measured, but the use of antibiotics is much more well-arranged now. There is progress in terms of the use of antibiotics based on the results of sensitivity tests and reducing the use of antibiotics for prophylaxis
4DDD hospitalCompliance is getting better, although some still have not obeyed. Those who have not complied more adhere to international guidelinesCompliance with sensitivity test results was perfectThere was significant progress in microbiologist laboratory services due to the hospital implementing AMR-CP. Analyses with the Geysen method showed that the rational use of antibiotics had reached 80%. Thus, it leads to the cost efficiency of antibiotics to billion rupiahs (hundred thousands dollars). At the same time, antimicrobial treatment quality is improving as a reference
5EEE hospitalClinical compliance is still lackingCompliance with sensitivity test results has not been evaluatedThe work performance of AMR-CP has never been evaluated, but since the implementation of AMR-CP in the hospital, the use of antibiotics is more controlled and rational
6FFF hospitalIt has not been evaluatedIt has not been evaluatedThe work performance of AMR-CP has not been seen, as the program just started around one year
7GGG hospitalNot all clinicians have implemented it because uniform understanding is not easy. They were generally accepted, especially among young cliniciansCompliance with sensitivity test results has not been evaluatedEven though there were no comprehensive evaluations on AMR-CP, the rational use of antibiotics increased; conversely, the irrational use of antibiotics decreased by 60%. In addition, there is an improvement in the quality of the use of antibiotics
8HHH hospitalCompliance with the guidelines was goodCompliance with sensitivity test results was good, mainly because it is in line with NHS guidelines. If it is outside NHS, then the claim will not be paidThere was a decrease in the use of antibiotics without a diagnosis of infection, from 80% to 77.7%, and the effectiveness was better, ranging from 70 to 80%. The cost aspect leads to being more efficient because the cost is lower. Overall, there were better quality and cost control
9III hospitalCompliance with the guidelines has been established but still needs to be improvedSome clinicians still need to comply with the results of sensitivity tests, and there are still doctors who use antibiotics in the long term without supporting data such as sensitivity test resultsThere was a change for the better quality of antibiotic use. Likewise, there was an improvement in antibiotic sensitivity and a decrease in multiresistant antimicrobials. There was also a decrease in the incidence of MRSA
10JJJ hospitalThere is no clinical compliance assessment yetIt has not been evaluatedAlthough not yet evaluated, AMR-CP has a cost-efficiency impact