A multicentre point prevalence survey of patterns and quality of antibiotic prescribing in Indonesian hospitals

Background Antibiotic misuse and overuse are a major driver of antimicrobial resistance, but systematic data in Indonesia are scarce. Objectives To evaluate patterns and quality indicators of antibiotic prescribing in six acute-care hospitals in Jakarta, Indonesia. Methods We conducted a hospital-wide point prevalence survey (PPS) between March and August 2019, using Global-PPS and WHO-PPS protocols. The analysis focused on antibacterials for systemic use (antibiotics). Results Of 1602 inpatients, 993 (62.0%) received ≥1 antimicrobials. Of 1666 antimicrobial prescriptions, 1273 (76.4%) were antibiotics. Most common reasons for prescribing were pneumonia (27.7%), skin and soft tissue infections (8.3%), gastrointestinal prophylaxis (7.9%), and gastrointestinal infections (5.4%). The most common indication was community-acquired infection (42.6%), followed by surgical prophylaxis (22.6%), hospital-acquired infection (18.5%), medical prophylaxis (9.6%), unknown (4.6%) and other indications (2.1%). The most prescribed antibiotic classes were third-generation cephalosporins (44.3%), fluoroquinolones (13.5%), carbapenems (7.4%), penicillins with B-lactamase inhibitor (6.8%) and aminoglycosides (6.0%). According to the WHO AWaRe classification, Watch antibiotics accounted for 67.4%, followed by 28.0% Access, 2.4% Reserve, and 2.2% Unclassified. Reason for prescribing, stop/review date and planned duration were poorly documented. Hospital antibiotic guidelines were not available for 28.1% of prescriptions, and guideline compliance was 52.2% (478/915). Parenteral administration was high (85.1%). Targeted (non-empirical) prescriptions comprised 8.1% (44/542) for community-acquired infections and 26.8% (63/235) for hospital-acquired infections. Conclusions Our data indicate a high rate of parenteral, empiric use of broad-spectrum antibiotics in Indonesian hospitals, coupled with poor documentation and guideline adherence. The findings suggest important areas for antimicrobial stewardship interventions.