# \[e-drug\] Antibiotic use and resistance in Vietnam **URL:** \ **Category:** e-drug\ **Created:** [February 18, 2004, 7:09am UTC](https://talk.edrugplus.org/t/e-drug-antibiotic-use-and-resistance-in-vietnam/18889 "2004-02-18T07:09:47Z")\ **Posts on this page:** 1\ **Page:** 1
**Author:** ![E-drug](https://avatars.discourse-cdn.com/v4/letter/e/ecd19e/32.png) [@E-drug](https://talk.edrugplus.org/u/E-drug)\ **Post date:** [February 18, 2004, 7:09am UTC](https://talk.edrugplus.org/t/e-drug-antibiotic-use-and-resistance-in-vietnam/18889/1 "2004-02-18T07:09:47Z")
E-drug: Antibiotic use and resistance in Vietnam ------------------------------------------------------------------------- [E-druggers, Below is the abstract of a PhD thesis on antibiotic use in Vietnam, which was presented in December 2003. The topic concerns me a lot, as the inappropriate use of antimicrobial agents in the world continues to receive relatively little attention. The thesis documents practices in antibiotic use, and interestingly, the large difference between what providers say they will do (to simulated clients) and what they do in reality. This suggests that correct knowledge on antibiotic use is only one of the determinants of good use. The good news is that antibiotic use can be changed, provided well designed interventions are implemented. The full thesis can be downloaded. For E-druggers interested in the issue of determinants of antibiotic use in developing countries, the following publications may be of interest: - Radyowijati A, Haak H. Determinants of antimicrobial use in the developing world. Child Health Research Project. Special Report, Volume 4, Number 1, 2002. [http://www.childhealthresearch.org/doc/AMR\_vol4.pdf](http://www.childhealthresearch.org/doc/AMR_vol4.pdf) - Radyowijati A, Haak H. Improving antibiotic use in low-income countries: An overview of evidence on determinants. Social Science and Medicine, 57(4), 733-744, August 2003. HH] "Antibiotic Use and Resistance: Assessing and Improving Provision and Utilization of Antibiotics and Other Drugs in Vietnam" Mattias Larsson Full thesis available for download from: [http://diss.kib.ki.se/2003/91-7349-630-8/](http://diss.kib.ki.se/2003/91-7349-630-8/) Abstract Background: In Vietnam there were shortages of drugs until the end of the 1980's. In 1986 the "Doi Moi" economic reforms towards market economy were initiated. An expanding private health care sector emerged and the per capita drug consumption has increased dramatically. Aim: To assess drug provision in the public and private sectors, antibiotic use and resistance in the community, as well as the effect of an intervention package aimed at improving case management in private pharmacies in Vietnam. Methods: Drug utilization was assessed in 6 provinces using 2400 prescriptions, 1200 drugs, 200 interviews with doctors and 200 medical records (I). Community antibiotic use and bacterial resistance was assessed among 200 children 1-5 years of age in the rural Bavi district using a questionnaire and disc diffusion tests (11). Antibiotic prescribing was assessed in relation to serum levels of C-reactive protein among 100 children 1-6 years who received antibiotic treatment (III), A randomized control trial assessed the effect of an intervention package (enforcement of regulation, education and peer influence) on case management of childhood mild respiratory infection, male sexually transmitted disease and dispensing of prescription only drugs (antibiotics and steroids) in 60 private pharmacies in Hanoi. Knowledge was assessed through interviews with a structured questionnaire pre and post intervention and practice through simulated client method with five encounters per pharmacy after each intervention (IV, V & VI). Results: Essential drugs were available in remote areas. The average number of drugs per prescription was high and injections were common (I) In Bavi 75% of the children had been treated with antibiotics within one month preceding the study, most commonly ampicillin, penicillin or amoxicillin. Of the carers deciding on treatment 67% consulted a drug seller, 22% a doctor and I I% decided themselves. Of the antibiotics 80% were purchased from private drug outlets. Of S. pneumoniae and, H. influenzae 90% and 68% were resistant to at least one antibiotic, respectively (88% and 32% to tetracycline, 32% and 44% to trimethoprim/ sulphonamide and 25% and 24% to chloramphenicol, respectively). There was a significant difference in ampicillin and penicillin resistance between the group of children previously treated with beta lactam antibiotics and the group of children not having received antibiotics (11). Elevated CRP concentrations (\>10 mg/L) were detected in only 17% of the children who had received antibiotic prescription (III). Of the pharmacy staff 20% stated that they would dispense antibiotics for a child with cough, in practice 83% of the pharmacies did. Fifty three percent stated that they would ask the patient questions related to breathing, in practice 10% did; Eighty one percent stated that antibiotics are not effective in short courses, in practice 47% dispensed for courses less than 5 days. Only 36% of the cases were handled according to guidelines (IV). Compliance with the prescription regulation was weak. Sixty percent said that they would not dispense steroids without prescription. In practice all but one pharmacy did (V). The intervention pharmacies improved significantly compared to the control pharmacies in all tracer conditions. For mild respiratory infections, antibiotic dispensing decreased and questions regarding rapid breathing increased. For sexually transmitted diseases, advice to go to the doctor and dispensing the correct symptomatic treatment increased. Dispensing of prednisolone and cephalexin decreased and prescription requests increased (VI). Conclusion: Considering the common practice of self-medication with antibiotics through private pharmacies and high levels of antibiotic resistance there is a need to improve drug utilization and provision in Vietnam. Promoting Good Pharmacy Practice standards towards improving case management in private pharmacies is likely to have a major public health impact. -- To send a message to E-Drug, write to: e-drug@healthnet.org To subscribe or unsubscribe, write to: majordomo@healthnet.org in the body of the message type: subscribe e-drug OR unsubscribe e-drug To contact a person, send a message to: e-drug-help@healthnet.org Information and archives: [http://www.essentialdrugs.org/edrug](http://www.essentialdrugs.org/edrug)