Abstract

Masih banyak ditemukan resep obat antituberkulosis anak dengan kombinasi beberapa obat dalam racikan puyer yang tidak sesuai standar program pemberantasan tuberkulosis (TB) paru Kementerian Kesehatan Republik Indonesia. Studi ini bertujuan untuk mengetahui situasi dan permasalahan berhubungan praktik peresepan puyer sebagai obat anti tuberkulosis (OAT). Pada periode Mei hingga Desember tahun 2009, penelitian diawali dengan pengukuran persentase peracikan OAT dalam bentuk puyer, dilanjutkan dengan penelitian kualitatif eksploratif. Data dikumpulkan dari rumah sakit, puskesmas, apotek dan dinas kesehatan di Jakarta, Bandung, Medan, dan Makassar. Pada tiap fasilitas kesehatan, 30 sampel resep pengobatan diambil untuk pasien tuberkulosis anak usia 1 - 12 tahun. Kemudian dilakukan wawancara mendalam terhadap dokter anak, apoteker, keluarga pasien, dan pegawai dinas kesehatan yang terkait. Penelitian menemukan persentase peracikan OAT adalah 25% untuk campuran rifampicin dan isoniazid, dan 18% untuk campuran rifampicin, isoniazid, dan pyrazinamid. Semua informan menyadari bahwa praktik peracikan puyer tergolong pengobatan yang irasional, tetapi situasi yang mereka hadapi membuat mereka terus meresepkan dan membuat peracikan puyer. Ketersediaan fixed dose combination (FDC) yang rendah untuk OAT serta harga yang mahal menjadi alasan utama. Pemerintah dan organisasi profesi perlu meningkatkan pembinaan secara terus menerus kepada tenaga kesehatan berhubungan serta meningkatkan akses masyarakat terhadap FDC untuk tuberkulosis anak. There are still many practices of treating sick children with a mixture of several medicines for children suffering from tuberculosis, called it “puyer”. It is not following the standard from Ministry of Health. This study explored the complex situation dealing with the practice of compounded medicines. It was innitially by assessment the percentage of “puyer” prescription, and followed by the qualitative study, from May to December 2009. Data were collected from hospitals, primary health cares and pharmacies in Jakarta, Bandung, Medan, and Makassar. From every health cares facilities, 30 prescriptions were collected for children age 1 to 12 years old. Then, we conducted in-depth interviews with pediatricians, pharmacist, patients’ families and health officers about “puyer” prescription for children. The prevalence of prescription consists of “puyer” for children were 25% for isoniazid and rifampicin and 18% for isoniazid, pyrazinamid, and rifampicin. All informants knew “puyer” prescription is irrational, because the complex situation they faced they continued to give “puyer” to patients. Low availability and high price of fixed doses combination (FDC) are main reasons. The government and association of doctors/pharmacist should enforce discipline to their member to obey therapy standard. The government should improve access to FDC medicines for children suffering tuberculosis.

References

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