Muchlis Achsan Udji Sofro

KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA

KEMENTERIAN KESEHATAN R I
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 MASALAH GLOBAL

PENGGUNAAN ANTIBIOTIK
PENEMUAN ANTIBIOTIK HARAPAN PADA MANUSIA
(Profilaksis, Terapi)

KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA

KEMENTERIAN KESEHATAN 2
 Rp

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MUNCUL MORBIDITAS dan MORTALITAS
akibat AMR

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Pencetus
resistensi
Layanan kedokteran/
Kesehatan

Peternakan

Masyarakat

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Di Layanan Medis dan Masyarakat

overuse
misuse
Rational
underuse

BAKTERI RESISTEN

KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA

KEMENTERIAN KESEHATAN 6
 di Peternakan

KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA

KEMENTERIAN KESEHATAN 7
Di Peternakan

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Di Peternakan

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10
MASALAH RESISTENSI
MENJADI KOMPLEKS

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MASALAH GLOBAL (MRSA)

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MASALAH GLOBAL (ESBL)

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MASALAH GLOBAL (Carbapenem resistant)

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penyebaran NDM-1 E.coli

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 The prevalence of ESBL producing E.coli and Klebsiella pneumoniae
among hospitals in Indonesia 2013

60 56,39% 56,8%
51,69% 52,23%
50 45,33%
40,83%
40 37,82%
34,31% 32,16% 32,7%
30 27,94% 26,71%

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10

0
RSDS RSSA RSDM RSDK RSSD RSP

Data surveillance PPRA - BALITBANGKES - WHO 2013-2014

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 MORTALITAS
2013 700.000 / tahun

2050 10.000.000/tahun
WHO 2013
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 Angka mortalitas 2050

mortality milion per year

10

6
10
8.2
4

2
1.5
0
AMR CANCER DM

CDC.
18 2014
 Pertanian/
Peternakan
Problems /perikanan
Map Growth Cegah
infeksi Regulasi
promotor

Food Kurikulum
Knowledge Residu AB Insentif
(+)

R AB / R Training/
OTC/Apatek
self AMR AB/ Knowledge seminar
medikas RS DR Workshop
i

Regulasi ASP
SDM Lab.
mikro Regulasi
SpMK

PNPK
KM/ PPK TOP
(-) MGT
KFT

IDI/
PDSP/
IAI
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 Kecepatan
penemuan
antibiotik

Timbulnya
resistensi
kuman

- Post antibiotic era

- Kembali ke zaman
pra antibiotik
- Peningkatan kematian
karena penyakit infeksi

Bagan Waktu
Spekulatif
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 Kecepatan
GOAL PPRA
penemuan
antibiotik

Timbulnya
resistensi
kuman

prevalensi
AMR

Antibiotik BIJAK
NAKES & masyarakat

Bagan Waktu
Spekulatif 21
 BAKTERI RESISTEN

Rational use

Mis-use • Efflux
• Degradation enzim
Over-use
• Altering enzim
• Biofilm
Under-use 22
KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA
KEMENTRIAN KESEHATAN 23
 2 STRATEGI
CEGAH RESISTENSI
CEGAH
SELECTIVE CEGAH
PRESSURE TRANSMISI

ANTIBIOTIK KEWASPADAAN
BIJAK STANDAR

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 Antibiotik
BIJAK
Penggunaan
antibiotik Rasional
+
kendali risiko
Resistensi

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 Cuci tangan Dekontaminasi Sampah medis

Alcohol handsrub Antisepsis stetoscope Sarung tangan & masker

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Peran RUMAH SAKIT
terhadap Penurunan
Prevalensi AMR

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 Global action plan on antimicrobial resistance
1. Improve awareness and understanding of
antimicrobial resistance through effective
communication, education and training
2. Strengthen the knowledge and evidence
base through surveillance and research
3. Reduce the incidence of infection through
effective sanitation, hygiene and infection
prevention measures
4. Optimize the use of antimicrobial
medicines in human and animal health
5. Develop the economic case for sustainable
investment that takes account of the
needs of all countries, and increase
investment in new medicines, diagnostic
tools, vaccines and other interventions

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29
 Peta Strategi PPRA di Indonesia 2015-2019

Increasing Public Health quality through

OUTCOME AMR Control Program
(Diagnostic, Antibiotik usage, Infection management, AMR Spreading,
Decreasing AMR Incidence )

Realization of Community Care toward AMR Global Update of AMR Collaboration

To Develop AMR Control Implementation in teaching material
Problem and control between Ministry of
Health Facilities ( (% understanding of AMR, % antibiotic consumption,% in Health health, ministry of
( % number of Health Facility included) education Agriculture and
decreasing antibiotic OTC))
OUTPUT

(Medical Doctor, vetenerary, ministry of

Pharmacetical, education
Nurse, Midwife)
STRATEGIC IMPLEMENTATION PROCES

Realization Realization of

Avaibility of AMR control Program funds

Realization Realization
of AMR education Realization Realization

Implementation of AMR surveillance

Realization of AMR of AMR
Control system of antibiotic of
of AMR Control in Control in
collaboration of AMR selling collaboration
Control in Primary Private
within Problem and control and between gov.
Hospital Health Practice
profesional control in monitoring and NGO
Facilities setting
organization community
Collaborat
Collaboratio
ion of
Collaborati Collaborati n between
ministry of
on among on of institution
agriculture
Realization of AMR Information system base on
Realization of AMR Information system base health medical that
and
health facilities
on community setting faculty / profession concern in
vetenerer
university collegium antibiotic
y
use
Existing system of AMR control in Health facilities and community
SUMBER DAYA
KESEHATAN

Avalaible competent health provider in for Facilities support for AMR Control
AMR conrtol program: Gov. Regulation support
(Phycisian, Clinical Microbiologist, Clinical
program :
(National Policy, National
pharmacist, Clinical Pharmacologist, ICN) (Diagnostic, IC, Pharmaceutical
guideline, Clinical guideline)
fascilities)

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KESEHATAN

Fasilitas Jumlah Profesi Jumlah

Rumah sakit 2.600 Dokter spesialis 36.000
Puskesmas 9.700
Dokter Umum 104.000
Apotek 24.000
FK 72 Dokter Gigi 23.700
FKG 27 Bidan 250.000
FF 71
Perawat 225.000
AKBID 720
AKPER 300 Farmasis 30.000
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 KEPUTUSAN MENTERI
KESEHATAN REPUBLIK
INDONESIA NOMOR
HK.02.02/MENKES/390/2014
TENTANG PEDOMAN PENETAPAN
RUMAH SAKIT RUJUKAN NASIONAL

KEPUTUSAN MENTERI KESEHATAN

REPUBLIK INDONESIA NOMOR
HK.02.02/MENKES/391/2014

TENTANG PEDOMAN PENETAPAN RUMAH

SAKIT RUJUKAN REGIONAL

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33
 Hospital ARCP Pathway 2016

• standardization of Hospital AMR

Program training
AMRCC of MoH
• Training of the Trainer
• research: AMR, Antibiotic use,
sepsis, AMR related infection
cost
14 National and
20 Provincials • National AB - AMR Surveillance
Referral Hospitals

110 Regional Private and District Primary

Referral Hospitals Hospitals Health Care

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 MENCEGAH INISIASI RESISTENSI
DI MASYARAKAT
1. REGULASI
– mencegah OTC antibiotik
– mengendalikan antibiotik pada pakan ternak
2. EDUKASI
– masyarakat tidak membeli bebas antibiotik
– tidak menyimpan antibiotik
– tidak memberikan antibiotik sisa
– peternak  bahaya resistensi
3. Manejerial support
– pembinaan, punishment bagi apotek, peternak

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Action Without Plan is better…
than Plan Without Action…
Best one is Plan and Action

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