Systematic Review: The Effect of ARI Recurrence on Unhealthy

Lifestyles

Mega Haryani and Ida Paulina

Master of Pharmacy, Faculty Pharmacy, University 17 August 1945 Jakarta, Indonesia

Keywords: ISPA, Unhealthy, Lifestyle.

Abstracts: ARI is a very serious infectious disease that occurs when the body's immune system weakens, for example

due to illness or stress. Viruses are the most common cause of ARI. The most common types of infection

are Rhinovirus (RhV), Respiratory Syncytial Virus (PSV), Influenza (IFN), Parainfluenza Virus (PIV),

Covid (CoV), Human Metapneumovirus (hMPV), Heterovirus (EV), Adenovirus (AdV) and Bocavirus

(HBoV). Antibiotics are substances or ingredients used to prevent and treat infections caused by bacteria. In

the United States there are 50 million unnecessary antibiotic prescriptions out of 150 million prescriptions

each year, the use of antibiotics continues to increase, which causes, among other things, inappropriate use

of drugs will cause many problems in terms of effectiveness, side effects, interactions, economics and drug

abuse, thus providing many negative impacts including quality and management of drug services, drug

resistance, side effects on patients, allergies for alergicpatients and psychosocial. This study aims to

determine the relationship between the use of antibiotics and the recurrence rate of ARI. The research

method used was a systematic review by searching for published articles related to the intensity of

recurrence in ARI patients who received antibiotics. Literature searches were conducted in July-August

2023 using electronic database searches, namely ProQuest and google scholar. The next international

journal search was conducted by the researchers through ProQuest with the keywords "relationship between

the use of antibiotics and recurrence in ARI patients" and the search year was limited from 2010 to 2017.

The results of the systematic review of 2 published journals showed that statistically there are factors that

influence ARI recurrence, namely cigarette smoke is very influential in ARI recurrence, and food intake

patterns can also affect nutritional status, and frequent interaction with people who have symptoms can

increase the risk of recurrent relapse.

1 INTRODUCTION

In developed countries, ARI is often caused by

viruses, whereas in developing countries it is caused

by bacteria such as Streptococcus pneumoniae and

Haemoplus influenzae, and is responsible for 10-

25% of deaths in developing countries. The

incidence of ARIs is also influenced by several

factors, including poor nutrition, indoor air

pollution, measles vaccination and lack of exclusive

breastfeeding. ARIs are generally mild in nature and

are usually caused by infections and

microorganisms. ARI is a disease caused by various

microorganisms and can cause contamination.

Deaths from the disease are 2-6 times higher in

developing countries. Contamination is one of the

variable causes of death in children under five

(Ministry of Health, 2018).

ARI is a very serious infectious disease caused

by a weakening of the body's immune system, for

example due to illness or stress. In the early stages,

symptoms include nasal pain, dryness and irritation,

followed by persistent wheezing, nasal congestion

with runny nose, fever and migraines. The outer

layer of the nasal mucous membrane appears red and

enlarged. As the disease progresses, mucus thickens

and nasal congestion increases. If there are no

problems, the symptoms disappear after 3-5 days.

Acute respiratory infections are a major cause of

death in agricultural countries. In general, ARI is a

disease of the upper or lower respiratory tract that is

usually contagious and can cause a variety of

illnesses, ranging from mild or asymptomatic

contamination, to asymptomatic or mild disease, to

persistent, severe and fatal disease, depending on

natural factors.

Haryani, M. and Paulina, I.

Systematic Review: The Effect of ARI Recurrence on Unhealthy Lifestyles.

DOI: 10.5220/0012642100003821

Paper published under CC license (CC BY-NC-ND 4.0)

In Proceedings of the 4th International Seminar and Call for Paper (ISCP UTA ’45 JAKARTA 2023), pages 205-209

ISBN: 978-989-758-691-0; ISSN: 2828-853X

205

The availability of different antibiotics requires

better knowledge to choose the right antibiotic to

treat ARI. Health education about ARI is an effort or

activity to help individuals, groups or communities,

especially parents, to improve their knowledge and

skills in caring for infants with ARI so that optimal

quality of health is achieved. ARI is one of the

infectious diseases that is a national priority.

Similarly, ARI is often characterised as a severe

respiratory illness caused by an intolerable specialist

sent from one person to another. Onset is usually

rapid, within a few hours to a few days. Symptoms

include fever, sore throat, coryza (runny nose),

shortness of breath, wheezing or difficulty breathing.

Unwanted natural conditions also build up diseases

that experts breed and work with the course of

disease transmission. One of the factors causing ARI

is also the actual climate conditions and the support

of the home climate. Supporting the home climate

by keeping the house tidy, controlling the air trade in

the house, keeping the home climate tidy and

seeking sunlight into the house during the day,

keeping the air guard in the house clean to prevent

microbes and including trying not to pack as it is

seen as a risk of expanding the incidence of ARI.

Viruses are the most common cause of ARI. The

types of infections that commonly cause ARI are

Rhinovirus (RhV), Respiratory Syncytial Virus

(PSV), Influenza (IFN), Parainfluenza Virus (PIV),

Covid (CoV), Human Metapneumovirus (hMPV),

Heterovirus (EV), Adenovirus (AdV) and Boca

Virus (HBoV) infection (Organisation, 2007).

About a third of antibiotic prescriptions for

children with URI may be inappropriate. A Finnish

study monitored antibiotic prescribing for children

with upper urinary tract infections over seven years.

During this time, the number of paediatric visits for

which antibiotics were prescribed increased. This

happens when the procedure for using antibiotics is

not appropriate. Inappropriate use of antibiotics can

lead to bacterial resistance to antibiotics, which

allows bacteria to adapt to their environment.

Several factors can increase the incidence of

recurrent ARI in young children, one of which is

parental smoking habits, as cigarette smoke is very

influential in the recurrence of ARI. Feeding

patterns can also affect nutritional status, and

frequent interaction with people who have

symptoms can increase the risk of relapse (Chand et

al, 2023).

2 RESEARCH METHODS

The research method used was a systematic review

by searching for published articles related to the

intensity of relapse in ARI patients who received

antibiotics. Literature searches were conducted in

July-August 2023 using electronic database

searches, namely ProQuest and google scholar. The

next international journal search was conducted by

the researchers through ProQuest with the keyword

"relationship between the use of antibiotics and the

recurrence of ARI patients" and the search year was

limited from 2010 to 2017. The national journal

search was conducted through Google Scholar with

the keywords "Relationship between the recurrence

rate of ARI patients and the use of antibiotics" and

the search year was limited from 2010 to 2017. The

journals and articles obtained were then filtered by

title and abstract. The articles selected by the

researcher were based on the desired criteria, namely

the relationship between recurrence and antibiotic

use. Journals that were not relevant to the research

topic were excluded. The selected journals were

evaluated according to the inclusion and exclusion

criteria of the study, and based on the sorting of

these criteria, journals suitable for the systematic

review were obtained. The inclusion criteria used in

the systematic review are journals published from

2010 to 2017, the use of antibiotics, patients with a

primary diagnosis of ARI, the intensity of relapse in

patients, socio-demographics of patients. Literature

search results, obtained 72 articles in ProQuest and

google scholar data. By selecting the title and

abstract of the article, 43 articles were obtained.

From this evaluation, 19 articles were excluded. The

remaining 10 articles had full manuscripts. From the

ten articles obtained, 4 articles were suitable for

systematic review.

Research design. The systematic review

identified four articles that used a cross-sectional

study design.

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3 RESULTS AND DISCUSSION

The results of the analysis of several articles

conducted in a systematic review, the factors that

influence the recurrence rate of patients who use

antibiotic therapy in ARI patients were obtained.

Factors that influence the recurrence of ARI are

cigarette smoke is very influential in the recurrence

of ARI and food intake patterns can also affect

nutritional status, and frequent interaction with

people who have symptoms may increase the risk of

recurrent relapse. Based on the results of a

systematic review of two articles, antibiotics are one

of the most commonly used treatments in healthcare

settings. However, it is important that antibiotics are

used rationally to provide optimal benefit according

to the patient's clinical needs, including the right

dose. Therefore, the rationality of antibiotic

administration is crucial (Ramlah et al., 20-21).

Research using respondent characteristics, namely

age, sex, diagnosis, antibiotic administration,

number of visits. Research (Tomatala et al., 2019)

suggests that respondent characteristics after chi-

squared test obtained significant results with the

recurrence rate of ARI patients, namely p value less

than 0.05. Patients who are male are 51-54.84%

more than patients who are female, and the age of

patients is more at the age of over 41 years (Reza et

al., 2020).

Research (Riswanto et al., 2018) shows that the

perception of one form of irrational prescribing is

the use of drugs when the indication of the disease is

needed, as in this study the use of antibiotics in

patients with ARI instead of pneumonia. The more

compliant respondents are in carrying out the steps

to establish the diagnosis of ARI. Factors

influencing the use of antibiotics include factors

related to prescribing, drug manufacturing and

patients. Prescribing factors can be influenced by

things such as the level of knowledge about the use

of antibiotics, where a low level of knowledge about

the use of antibiotics can lead to misdiagnosis and

difficulty in distinguishing between bacterial and

viral infections. The availability of diagnostic

facilities and supporting investigations, patient

demand, drug promotion, level and frequency of

supervision in this case seen from the level of

supervision whether strict or not strict and the

frequency of supervision. Supervision by superiors

may increase the rationality of antibiotic use or,

conversely, may lead to under- or over-prescription

of antibiotics due to concerns about prescribing. The

high prevalence of ARIs and their impact leads to

high consumption of over-the-counter medicines

(such as anti-influenza, cough medicines,

multivitamins) and antibiotics. The high incidence of

ARI, including pneumonia, in children under five is

due to the high frequency of recurrent ARI in

children under five. The use of antibiotics for acute

respiratory infections, especially in patients under

five years of age, who are the most affected by ARI,

requires special attention.

The results obtained the use of antibiotics against

ARI infants as much as 53.95%, infants experienced

Systematic

Review

Issued, N=8

The research method does not

match the research criteria.

Full Manuscript

Assessment

Excluded, N = 19

Title does not fit the study criteria,

not related to haemodialysis patients

Selection based on title and abstract

N=43

Database Search

N=72

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207

a recurrence of 46.34% and Chi Square test obtained

a p value of 0.004 (p = <0.05). In this study, the use

of antibiotics in ARI is often irrational. Data from

the Ministry of Health in 2011 showed that 60% of

patients with ARI used antibiotics inappropriately,

i.e. too high or inappropriate dosage, inappropriate

duration of use, prescription of drugs not according

to diagnosis and self-medication with drugs that

should be obtained by prescription. Taking

antibiotics too often means killing all the good

bacteria that are beneficial to the body. When the

population of benign germs that are beneficial to the

body is wiped out, the balance of the body's

microorganisms can be disturbed, so that fungi that

were previously afraid of germs in our bodies have

the opportunity to attack more easily, causing

recurrences or new diseases (Tomatala et al., 2019).

The use of antibiotics that are not in accordance with

therapeutic studies will increase negative effects,

such as bacterial immunity to some antibiotics,

increased incidence of drug side effects, high health

care costs. On the basis of all this, the use of

antibiotics needs to be regulated so that it can be

used appropriately with a structural approach. If

antibiotics are widely used in hospitals and other

health services in inaccurate doses and for long

periods, resistance will develop (Riswanto et al.,

2018).

If antibiotics are administered at too low a dose,

bacterial resistance to the drug will develop, leading

to increased healthcare costs. Factors that affect the

maximum effect of drugs include determining the

correct dose, route and duration of administration.

The pharmacokinetic and pharmacodynamic

properties of the drug will affect the amount of dose

and the method and frequency of administration,

while the duration of drug administration is based on

the nature of the disease, such as acute, chronic or

recurrent. The main cause of antibiotic resistance is

the widespread and irrational use of antibiotics.

Approximately 80% of antibiotic consumption is for

human use and at least 40% is based on

inappropriate indications such as viral infections.

Factors that can lead to failure of antibiotic therapy

include the emergence of resistant organisms or

organisms that infect changes that can cause disease

recurrence (MOH RI, 2013). Standard prescribing is

rational drug prescribing, i.e. prescribing drugs

according to the standards used. Standard drug

prescribing means prescribing drugs that are correct,

clear and in accordance with patients' needs, taking

into account the type of drug, dosage, duration of

administration and affordability for the community.

Inappropriate drug prescribing leads to inappropriate

treatment, which can have consequences such as the

emergence of antimicrobial resistance, the

occurrence of adverse effects, excessive financial

expenditure and relapse due to the use of drugs that

exceed the limit.

Antibiotics are a class of drugs used to treat and

prevent infections, so antibiotics are used when there

is an infection or for prophylactic purposes (to

prevent infection). Antibiotics are drugs that are

widely used to treat infections caused by bacteria.

Various studies have shown that about 40-62% of

antibiotics are used inappropriately, including for

conditions that do not require antibiotics. The use of

antibiotics that is not in accordance with therapeutic

studies will increase negative effects, such as

bacterial immunity to some antibiotics, increased

incidence of drug side effects, and high health care

costs. On the basis of all this, the use of antibiotics

needs to be regulated so that it can be used

appropriately with a structural approach. If

antibiotics are widely used in hospitals or other

health services in inaccurate doses and for long

periods, they will become resistant (WHO, 2021). In

the study (Azzahra et al., 2023) The data collection

process used secondary data, then the data were

processed using univariate analysis and bivariate

analysis, this analysis was used to determine the

hypothesis by determining the relationship between

variables with the antibiotic.

Chi-square analysis test. Based on the bivariate

analysis of the relationship between antibiotic use

and ARI recurrence, it shows that out of 106

samples given antibiotics, 80 (49.7%) experienced a

recurrence and those who did not relapse were 26

(16.1%). While the group of samples that were not

given antibiotics there were 53 samples consisting of

49 (30.4%) who relapsed and 6 (3.8%) who did not

relapse. From the results of the statistical analysis to

see the relationship between antibiotic use and ARI

recurrence, a value of p=0.040 was obtained,

indicating a significant relationship between

antibiotic use and ARI recurrence. The high

prevalence of ARI in the study area has an impact on

increasing the use of antibiotics and over-the-

counter medicines and increasing the risk of ARI

recurrence, especially in children under five. These

effects significantly increase the incidence of ARI in

the area. The results of Kausar's research (Kausar,

2020) showed that out of 137 populations, 70

patients diagnosed with ARI and using antibiotics,

with an age category ≤5 years, 38 (54.28%) of them

were infants. This shows that there are still many

young children diagnosed with ARI who are given

antibiotics. In addition, the study also showed that

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young children aged 1-5 years are at high risk of

relapse because their immune system is not fully

developed and their age of growth and development

increases their exposure to the outside world.

Therefore, it is important to consider these risk

factors when treating ARI in young children, as the

disease may have a worse clinical impact in infants

and children compared to adults (Yoon et al., 2017).

4 CONCLUSION

Based on research from systematic reviews that

cigarette smoke is very influential in the recurrence

of ARI, and food intake patterns may also affect

nutritional status, and frequent interaction with

people who have symptoms may increase the risk of

recurrence. The use of antibiotics that are not in

accordance with therapeutic studies will increase

negative effects, such as bacterial immunity to some

antibiotics, and giving antibiotics that are under-

dosed will cause bacterial resistance to these drugs,

which will cause health to deteriorate and the

intensity of relapse to increase. There is a

relationship between the use of antibiotics and the

relapse rate of ARI, where the higher the use of

antibiotics in patients with non-pneumonia ARI, the

more likely they are to relapse.

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