ABSTRACT

Acute Respiratory Infection (ARI) is one of the main causes of patient visits in Community Health
Center (Puskesmas) (40%-60%) and hospitals (15%-30%). Pharyngitis is an inflammation of the
pharyngeal wall caused by viruses (40%-60%) and bacteria (5%-40%). ARI stewardship program
specifically aims to reduce morbidity and mortality, especially in infants and toddlers, however the
morbidity and mortality rates are still high as reported in the Result of Basic Health Research of
2013. This study aimed to compare two methods of identifying the causes of acute pharyngitis using
Centor Criteria and analysis of symptoms, signs and comorbidities, evaluate the rationality of
antibiotic use; identify the impact of irrationality; and see if there was any relationship between
patient adherence and the outcome of therapy of acute pharyngitis patients. This was a descriptive
observational study involving evaluation the rational use of medicine, carried out retrospectively
and concurrently at the Community Health Center (Puskesmas) Ciumbuleuit, Bandung in the period
of March-June 2018. The results of the identification of causes of acute pharyngitis in both
retrospective and concurrent phases showed no significant differences whether the evaluation was
based on the Centor Score method or the method of analysis of symptoms, signs, and comorbidities
(p = 0.830 and p = 0.593). In the retrospective phase, there were 59.55% of patients received
antibiotic therapy albeit only an average of 27.7% of patients who were indicated to receive
antibiotics. In the concurrent phase, the rationality of antibiotic use comprised the accuracy of the
indication (46.67%), the accuracy of drug selection (87.5%), and the accuracy of the dose (100%),
but there was inaccuracy in duration of antibiotic given to almost all patients. The results of
therapeutic outcomes showed that 73.33% patients received good therapeutic results, with
antibiotics and without antibiotics. The condition of patients with persistent symptoms after
receiving antibiotics was thought to be due to patient’s non-compliance (26.67%). The irrationality
of antibiotic use could have an impact on the emergence of bacterial resistance to antibiotics and
the increased risk of side effects in patients