Rationality of antibiotic prescribing in basic- and intermediate-level accredited primary health centres in Depok, Indonesia

Abstract

Background: Previous research has identified a high irrationality of antibiotic usage among accredited primary health centres (PHCs). Implementing health system accreditation in Indonesia will encourage health facilities to rationalise antibiotic use. Objective: To evaluate antibiotics' prescribing pattern and rationality in basic and intermediate accredited PHCs after implementing health system accreditation. Method: A cross-sectional study was conducted at each of two basic- and intermediate-accredited PHCs in Depok, Indonesia. All antibiotic prescriptions from January to March 2020 were included in the prescribing pattern, while 384 prescriptions from each PHC were randomly sampled to evaluate the rationality using the PHCs clinical guidelines. Result: Amoxicillin was the most prescribed in the basic accredited PHCs (61%) and intermediate accredited PHCs (83.9%). Most of the antibiotics were used to treat respiratory tract (64.1%), teeth (12.0%), skin (7.8%), and other kind of infections. Irrational prescribing of antibiotics was found in basic and intermediate health centres in the form of duration of administration (75.7% and 79.3%), selection (18.6% and 14.2%), frequency (14.4% and 3.4%), and dosage (11.8% and 1.4%) respectively. Conclusion: After implementing the accreditation system, irrational use of antibiotics remains common, but PHCs with higher accreditation levels tend to show more rational antibiotic use.