The Role of Legal Advocacy in Controlling Non-Prescription Antibiotic Use in Indonesia
DOI:
https://doi.org/10.15294/ijals.v7i1.22252Keywords:
Antibiotics, Control, Regulation, Antimicrobial Resistance, Public EducationAbstract
The provision of antibiotics without doctor's prescription is serious problem in the Indonesian health system, which has impact on increasing antimicrobial resistance (AMR). Although regulations related to antibiotic use have been implemented, there are still gaps between the rules and implementation in the field. This study uses empirical legal method to analyze the effectiveness of controlling the use of antibiotics without doctor's prescription, challenges in its supervision, and strategies that can be applied to limit this practice. The results of the study show that although various regulations have strictly regulated the distribution of antibiotics, the level of pharmacy compliance with these rules is still low. A study conducted by the Indonesian Pharmacists Association (IAI) in 2023 showed that 79.5% of pharmacies still serve the purchase of antibiotics without a prescription, with a dominance in urban areas (82.3%) compared to rural areas (71.8%). The main factors causing this violation are weak supervision, legal sanctions that are not sufficiently deterrent, and high demand from the community. In addition, the lack of health education contributes to misuse of antibiotics, which risks increasing bacterial resistance and economic burden on the health system. Strengthening supervision and law enforcement of antibiotic distribution, implementing an electronic system for recording prescriptions, and educational campaigns for community and pharmacists are needed. With a stricter and more synergistic control strategy, practice of prescribing antibiotics without prescription can be minimized, so that the risk of antimicrobial resistance can be suppressed and effectiveness of treatment can be maintained.
References
Afladhanti, Putri Mahirah, Arya Marganda Simanjuntak, and Yohanes Firmansyah. “Tinjauan Hukum Penjualan Antibiotik Tanpa Resep Dokter Pada Era E - Commerce Di Indonesia.” Kongres Ke-6 MHKI : Presented Masyarakat Hukum Kesehatan Indonesia, 2024, 328–43.
Alajmi, Areej M., Abdullah A. Alamoudi, Abdulrahman A. Halwani, Thamer A. Almangour, Nada H. Almozain, Ahmed Al-Jedai, and Essam A. Tawfik. “Antimicrobial Resistance Awareness, Antibiotics Prescription Errors and Dispensing Patterns by Community Pharmacists in Saudi Arabia.” Journal of Infection and Public Health 16, no. 1 (2023): 34–41. https://doi.org/10.1016/j.jiph.2022.11.026.
Alhomoud, Faten, Zainab Aljamea, Reem Almahasnah, Khawlah Alkhalifah, Lama Basalelah, and Farah Kais Alhomoud. “Self-Medication and Self-Prescription with Antibiotics in the Middle East—Do They Really Happen? A Systematic Review of the Prevalence, Possible Reasons, and Outcomes.” International Journal of Infectious Diseases 57 (2017): 3–12. https://doi.org/10.1016/j.ijid.2017.01.014.
Ali, Achmad. Menjelajahi Kajian Empiris Terhadap Hukum. Jakarta: Kencana, 2012.
Alrasheedy, Alian A, Muath A Alsalloum, Feras A Almuqbil, A Muaath, Bandar S Aba Alkhayl, Ahmed S Albishri, Faisal F Alharbi, et al. “Expert Review of Anti-Infective Therapy The Impact of Law Enforcement on Dispensing Antibiotics without Prescription : A Multi-Methods Study from Saudi Arabia.” Expert Review of Anti-Infective Therapy, 2019, 1–12. https://doi.org/10.1080/14787210.2020.1705156.
Aslam, Adeel, Shazia Jamshed, Che Suraya Zin, Norny Syafinaz Ab Rahman, Syed Imran Ahmed, Zita Lívia Szabó, and Márió Gajdács. “Understanding the Determinants Influencing Self-Medication with Antibiotics Among Malaysian Residents: A Qualitative Study to Inform Preventive Public Health Strategies.” Antibiotics 13, no. 11 (2024): 1–19. https://doi.org/10.3390/antibiotics13111070.
Badan Pengawas Obat dan Makanan (Badan POM). Pedoman Penggunaan Antibiotik di Indonesia. Jakarta: Badan POM, 2011.
———. Laporan Audit Distribusi Antibiotik di Indonesia. Jakarta: BPOM, 2023.
———. Investigasi Undercover BPOM di 120 Apotek Jawa-Bali. Jakarta: BPOM, 2024.
Batista, Ana Daniela, Daniela A Rodrigues, Adolfo Figueiras, Maruxa Zapata-cachafeiro, F Roque, and Maria Teresa Herdeiro. “Antibiotic Dispensation without a Prescription Worldwide : A Systematic Review.” Antibiotics 9, no. 786 (2020): 1–49.
Bocquier, Aurélie, Anaïs Essilini, Ouarda Pereira, Adeline Welter, Céline Pulcini, and Nathalie Thilly. “Impact of a Public Commitment Charter, a Non-Prescription Pad and an Antibiotic Information Leaflet to Improve Antibiotic Prescription among General Practitioners: A Randomised Controlled Study.” Journal of Infection and Public Health 17, no. 2 (2024): 217–25. https://doi.org/10.1016/j.jiph.2023.11.027.
Bouldouyre, M. A., B. Mollo, F. Stordeur, and L. Nutte. “Mise En Place Des Centres Régionaux En Antibiothérapie (CRAtb) : Définition et Rôle de Ces Nouveaux Acteurs Du Bon Usage En Antibiothérapie En France Establishment of Regional Antimicrobial Stewardship Coordination Centres (CRAtb) in French Administrative.” Journal de Pediatrie et de Puericulture 37, no. 1 (2024): 8–14. https://doi.org/10.1016/j.jpp.2023.10.002.
Djawaria, Dewi Paskalia Andi, Adji Prayitno Setiadi, and Eko Setiawan. “Pengembangan Kuesioner Dan Identifikasi Faktor Penyebab Penjualan Antibiotik Tanpa Resep Dokter Di Komunitas Kota Surabaya.” Jurnal Manajemen Dan Pelayanan Farmasi 8, no. 3 (2018): 105–18. http://repository.ubaya.ac.id/id/eprint/34134.
Dyar, O. J., B. Beović, V. Vlahović-Palčevski, T. Verheij, dan C. Pulcini. "How Can We Improve Antibiotic Prescribing in Primary Care?" Expert Review of Anti-Infective Therapy 14, no. 4 (2016): 403–413. https://doi.org/10.1586/14787210.2016.1151353.
Essilini, Anaïs, Gaëlle Le Dref, Aurélie Bocquier, Joëlle Kivits, Adeline Welter, Céline Pulcini, and Nathalie Thilly. “French General Practitioners’ and Patients’ Acceptability of a Public Commitment Charter and Patient Information Leaflets Targeting Unnecessary Antibiotic Use: A Qualitative Study.” Antimicrobial Resistance and Infection Control 11, no. 1 (2022): 1–9. https://doi.org/10.1186/s13756-022-01065-3.
Faure, H., S. Mahy, A. Soudry, M. Duong, P. Chavanet, and L. Piroth. “Déterminants de La Prescription Ou de La Non-Prescription d’antibiotiques En Médecine Générale.” Medecine et Maladies Infectieuses 39, no. 9 (2009): 714–21. https://doi.org/10.1016/j.medmal.2009.05.002.
Fuertes, Marina, Anabela Faria, Joana L. Gonçalves, Sandra Antunes, and Francisco Dionisio. “Antibiotic Consumption, Illness, and Maternal Sensitivity in Infants with a Disorganized Attachment.” Children 10, no. 7 (2023): 1–14. https://doi.org/10.3390/children10071232.
Herawati, Fauna, Sheny Clarin Ananta, Ida Ayu Andri Parwitha, Sylvan Septian Ressandy, Nur Laili Rahmatin, Nur Afifah Rachmadini, Veronika Ayu Tangalobo, et al. “Interview-Based Cross-Sectional Needs Assessment to Advance the Implementation of an Effective Antibiotic Stewardship Program in Indonesian Hospitals.” Health Policy OPEN 1, no. 100002 (2020): 1–8. https://doi.org/10.1016/j.hpopen.2019.100002.
Hossain, Md Sabbir, Md Fakrul Islam, Prosenjit Basak Arka, Mahfuzer Rohman, Talha Sheikh Ahmed, Tanvir Ahammed, Muhammad Abdul Baker Chowdhury, and Md Jamal Uddin. “Antibiotic Prescription from Qualified Sources for Children with Fever/Cough: Cross-Sectional Study from 59 Low- and Middle-Income Countries.” EClinicalMedicine 61, no. 113035 (2023): 1–14. https://doi.org/10.1016/j.eclinm.2023.102055.
Ikatan Apoteker Indonesia. Laporan Studi Cross-Sectional tentang Distribusi Antibiotik di Apotek. Jakarta: IAI, 2023.
Kementerian Kesehatan Republik Indonesia. Peraturan Menteri Kesehatan Nomor 35 Tahun 2014 tentang Standar Pelayanan Kefarmasian di Apotek. Jakarta: Kementerian Kesehatan, 2014.
———. Peraturan Menteri Kesehatan Nomor 28 Tahun 2021 tentang Pedoman Penggunaan Antibiotik. Jakarta: Kementerian Kesehatan, 2021.
———. Pedoman Umum Penggunaan Antibiotik. Jakarta: Kementerian Kesehatan, 2011.
———. Rencana Aksi Nasional Pengendalian Resistensi Antimikroba (RAN-PRA). Jakarta: Kementerian Kesehatan, 2017.
———. Laporan Surveilans Resistensi Antimikroba Periode 2021-2024. Jakarta: Kementerian Kesehatan, 2024.
———. Laporan Survei Kesehatan Masyarakat terkait Penggunaan Antibiotik tanpa Resep. Jakarta: Kementerian Kesehatan RI, 2023.
Khan, Faiz Ullah, Farman Ullah Khan, Khezar Hayat, Tawseef Ahmad, Amjad Khan, Jie Chang, Usman Rashid Malik, Zakir Khan, Krizzia Lambojon, and Yu Fang. “Knowledge, Attitude, and Practice on Antibiotics and Its Resistance: A Two-Phase Mixed-Methods Online Study among Pakistani Community Pharmacists to Promote Rational Antibiotic Use.” International Journal of Environmental Research and Public Health 18, no. 3 (2021): 1–16. https://doi.org/10.3390/ijerph18031320.
Komang, Ni, Novita Dewi, and Debby Juliadi. “Faktor Penyebab Perilaku Penjualan Dan Pembelian Antibiotik Tanpa Resep Dokter : Studi Literatur.” Jurnal Farmasi & Sains Indonesia 4, no. 2 (2021): 19–25. https://doi.org/10.52216/jfsi.vol4no2p19-25.
Kurdi, Sawsan, Abrar Faran, Eman Eareeni, Noor Alhalal, Royes Joseph, Haytham Wali, and Dhafer Alshayban. “Assessment of Knowledge and Attitude toward the New Antibiotic Dispensing Law and Its Effect on Antibiotic Use in Saudi Arabia.” Saudi Pharmaceutical Journal 28, no. 1 (2020): 58–67. https://doi.org/10.1016/j.jsps.2019.11.005.
Lembaga Eijkman. Analisis Biaya-Manfaat Penggunaan Antibiotik di Indonesia. Jakarta: Lembaga Eijkman, 2024.
Limato, Ralalicia, Gilbert Lazarus, Puck Dernison, Manzilina Mudia, Monik Alamanda, Erni J. Nelwan, Robert Sinto, Anis Karuniawati, H. Rogier van Doorn, and Raph L. Hamers. “Optimizing Antibiotic Use in Indonesia: A Systematic Review and Evidence Synthesis to Inform Opportunities for Intervention.” The Lancet Regional Health - Southeast Asia 2, no. 6 (2022). https://doi.org/10.1016/j.lansea.2022.05.002.
Llor, Carl, Ria Benkő, and Lars Bjerrum. “Global Restriction of the Over-the-Counter Sale of Antimicrobials: Does It Make Sense?” Frontiers in Public Health 12 (2024): 1–4. https://doi.org/10.3389/fpubh.2024.1412644.
Mailuhuw, Hubertus Veron, Theresia Louize Pesulima, and Yosia Hetharie. “Perlindungan Konsumen Terhadap Penjualan Obat Antibiotik Tanpa Resep Dokter.” Pattimura Law Study Review 1, no. 1 (2023): 336–46.
Mallah, Narmeen, Nicola Orsini, Adolfo Figueiras, and Bahi Takkouche. “Education Level and Misuse of Antibiotics in the General Population: A Systematic Review and Dose–Response Meta-Analysis.” Antimicrobial Resistance and Infection Control 11, no. 1 (2022): 1–22. https://doi.org/10.1186/s13756-022-01063-5.
Ndaki, Pendo M, Martha F Mushi, Joseph R Mwanga, Eveline T Konje, Nyanda E Ntinginya, Blandina T Mmbaga, Katherine Keenan, et al. “Dispensing Antibiotics without Prescription at Community Pharmacies and Accredited Drug Dispensing Outlets in Tanzania: A Cross-Sectional Study.” Antibiotics 10, no. 1025 (2021): 1–15.
Nguyen, Nam Vinh, Nga Thi Thuy Do, Dung Tien Viet Vu, Rachel C. Greer, Sabine Dittrich, Maida Vandendorpe, Thach Ngoc Pham, et al. “Outpatient Antibiotic Prescribing for Acute Respiratory Infections in Vietnamese Primary Care Settings by the WHO AWaRe (Access, Watch and Reserve) Classification: An Analysis Using Routinely Collected Electronic Prescription Data.” The Lancet Regional Health - Western Pacific 30, no. October 2022 (2023): 100611. https://doi.org/10.1016/j.lanwpc.2022.100611.
Ouedraogo, A. S., H. Jean Pierre, A. L. Bañuls, R. Ouédraogo, dan S. Godreuil. "Émergence et diffusion de la résistance aux antibiotiques en Afrique de l’Ouest : facteurs favorisants et évaluation de la menace." Médecine et Santé Tropicales 27, no. 2 (2017): 147–154. https://doi.org/10.1684/mst.2017.0678.
Rather, Irfan A., Byung Chun Kim, Vivek K. Bajpai, and Yong Ha Park. “Self-Medication and Antibiotic Resistance: Crisis, Current Challenges, and Prevention.” Saudi Journal of Biological Sciences 24, no. 4 (2017): 808–12. https://doi.org/10.1016/j.sjbs.2017.01.004.
Servia-dopazo, Miguel, and Adolfo Figueiras. “Determinants of Antibiotic Dispensing without Prescription: A Systematic Review.” Journal of Antimicrobial Chemotherapy 73 (2018): 3244–53. https://doi.org/10.1093/jac/dky319.
Supadmo, Darto, Jaury Douglas, Nefrisa Maaruf, and Irwan Triadi. “Penerapan Hukum Dalam Menanggulangi Penyalahgunaan Antibiotik: Tantangan, Solusi, Dan Dampak Terhadap Keamanan Kesehatan Masyarakat Di Indonesia.” Jurnal Hukum Dan Kewarganegaraan 8, no. 9 (2024): 1–18.
Suzanalisa, and Nuraini Zachman. “Pertanggungjawaban Pidana Terhadappelaku Tindak Pidana Mengedarkan Obat Tanpa Izin Edar Suzanalisa,.” Legalitas: Jurnal Hukum 14, no. 1 (2022): 146–55. https://doi.org/10.33087/legalitas.v14i1.323.
Thandar, MM, Baba, T, Matsuoka, S, dan Ota, E. Interventions to Reduce Non‐Prescription Antimicrobial Sales in Community Pharmacies. Cochrane Database of Systematic Reviews 2025, no. 1 (2025): Art. No. CD013722. https://doi.org/10.1002/14651858.CD013722.pub2.
Torres, Neusa F., Buyisile Chibi, Desmond Kuupiel, Vernon P. Solomon, Tivani P. Mashamba-Thompson, and Lyn E. Middleton. “The Use of Non-Prescribed Antibiotics; Prevalence Estimates in Low-and-Middle-Income Countries. A Systematic Review and Meta-Analysis.” Archives of Public Health 79, no. 1 (2021): 1–15. https://doi.org/10.1186/s13690-020-00517-9.
Widayat, Edi. “Perlindungan Hukum Pasien Terhadap Pemberian Obat Yang Tidak Rasional Dalam Upaya Keselamatan Pasien.” Jurnal Spektrum Hukum 14, no. 2 (2017): 250–64.
World Health Organization. Antimicrobial Resistance in Southeast Asia: Regional Report. Geneva: WHO, 2024.
———. No Time to Wait: Securing the Future from Drug-Resistant Infections. Geneva: WHO, 2019. https://www.who.int/publications/i/item/no-time-to-wait-securing-the-future-from-drug-resistant-infections.
Zaffagnini, A., E. Rigotti, F. Opri, R. Opri, G. Simiele, M. Tebon, M. Sibani, G. Piacentini, E. Tacconelli, and E. Carrara. “Enforcing Surveillance of Antimicrobial Resistance and Antibiotic Use to Drive Stewardship: Experience in a Paediatric Setting.” Journal of Hospital Infection 144 (2024): 14–19. https://doi.org/10.1016/j.jhin.2023.12.001.
Downloads
Published
Article ID
22252Issue
Section
License
Copyright (c) 2025 Muhammad Adymas Hikal Fikri, Aprila Niravita, Indah Zunita Sari, Altares Ainun Qadisah , Berdibek Tursunov, Elsa Ratna Duhita (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Authors retain copyrights of the published materials under an Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) license. All writings published in this journal are the personal views of the authors and do not represent the views of this journal and the author's affiliated institutions.
