Antibiotic susceptibility profile.
The main focus of our study was to evaluate the current prevalence of bacteria responsible for ARTIs among the population in the urban area of Tasikmalaya, Indonesia. Our study investigated the correlation between pathogenic bacteria causing ARTIs and the antibiotic susceptibility profile commonly used by medical practitioners in public health centers. The test results obtained can be a comparative study regarding the effectiveness of cefixime and tetracycline as drugs of choice in the treatment of ARTIs. The disk antibiotic concentration used in accordance with CLSI guidelines are cefixime 5 µg, and tetracycline 30 µg [14].
Antibiotic susceptibility test carried out on 466 bacterial isolate stocks showed that cefixime was superior to tetracyclines in the treatment of ARI. Cefixime showed a lower resistance level of 38.0% when compared to 92.86% tetracyclines. These results are also consistent with other studies that cefexime is more effective in the treatment of respiratory infections compared to other drugs (eg ofloxacin, amoxicillin, and ciprofloxacin) [20, 21], The susceptibility of categories of isolates of both antibiotics are shown in Fig. 1.
These results will provide important information to the Health Office of the City of Tasikmalaya to determine the antibiotic procurement policy for public health centers, and evaluate the pattern of prescribing antibiotics for ARTIs treatment by practicing doctors. Synergic cooperation and coordination between all health professions in the prevention of ARI is also very necessary.
Biochemical Conventional Identification.
Biochemical conventional identification were carried out on 466 stocks of bacterial isolates, identified as Gram-negative, Gram-positive, bacilli (rod-shaped), coccoid (rod-shaped), coccobacilli. Results analyzed bacteria, the biochemical conventional tests revealed 5 genus of bacteria: Bordetella, Corynebacterium, Staphylococcus, Streptococcus, Haemophilus (Table 1 and Fig. 2).
Table 1
Results of biochemical test.
Group of bacteria
|
Shape
|
Gram
|
Genus
|
Biochemical Test
(Positive)
|
1
2
3
4
5
|
coccobacillus-capsulated
bacilli-rod shaped
round-shaped
Coccus-capsulated
Coccobacilli
|
Negative
Positive
Positive
Positive
Negative
|
Bordetella
Corynebacterium
Staphylococcus
Streptococcus
Haemophilus
|
OX, CT,UR
MR, CT, TSIA, LAC, MAN, MAL
CT, MR, VP, UR, SC, LAC, MAN, MAL
LAC, MAL
CT, OX, MAL
|
Several studies have shown similar results that of bacteria from the genus Bordetella, Haemophilus, Corynebacterium [22, 23, 24, 25]. Similar study conducted by Chopra et al. (2001) showed that Streptococcus haemoliticus, Staphylococcus, and Corynebacterium diphtheriae against tetracycline antibiotics [26]. Cefexime is also reported to have started decreasing susceptibility patterns of these bacterial pathogens, Streptococcus pneumoniae, Haemophilus influenzae with low resistance levels. [20]. Schico GC reported relevant information that cefexime showed decreased sensitivity to Staphylococcus, and streptococcus but was still very active than cefaclor and cefuroxime against Gram-negative respiratory pathogens [27].
However, some authors still highly recommend cefexime as a first-line antibiotic in overcoming cases of resistance to URTI and LRTI, especially against the pathogens Streptococcus pneumonaie, Streptococcus pyogenes, Hemophylus influenza, Moraxella catarrhalis [28, 29, 30]. Other studies have also demonstrated good clinical efficacy data of cefexime in URTI and acute otitis media (AOM) cases, where community-induced infections exhibit high rates of resistance to macrolides and are highly sensitive to cefexime [31, 32].
Coordination with local policy holders of the Tasikmalaya City Health Office regarding the evaluation of the use of antibiotics in the treatment of ARTIs has been carried out. Preventive policies and education such as the intervention of antimicrobial stewardship programs (ASPs) at reducing unnecessary antibiotic prescribing, including training communication between health professionals, accountable justification of health programs, feedback by comparing socio-behavioral responses through questionnaires. Making handouts that are distributed to patients in community health centers as part of a program to educate the public about the use of appropriate antibiotics can support the success of ARTIs therapy. We plan to measure the impact of these interventions in the near future.