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