Antibiotic use and resistance in emerging economies: a situation analysis for Viet Nam

BMC Public Health

Heiman FL Wertheim⁸  Tran Tinh Hien⁴  Jeremy Farrar⁴  Mai Thanh Hoang²  Ha Bich Thi Ngo¹  Peter Horby⁸  Hellen Gelband⁶  Ramanan Laxminarayan⁶  Babatunde Olowokure⁶  Socorro Escalante⁶  Mattias Larsson⁴  Chuc Kim Thi Nguyen³  An Quoc Nguyen⁵  Phuong Mai Doan⁷  Ca Van Pham⁹  Trung Vu Nguyen³  Arjun Chandna⁴  Nga Thuy Thi Do⁴  Kinh Van Nguyen⁹ 

[1] Medical Service Administration, Ministry of Health, Hanoi, Viet Nam;Drug Administration of Viet Nam, Ministry of Health, Hanoi, Viet Nam;Hanoi Medical University, Hanoi, Viet Nam;Oxford University Clinical Research Unit, Hanoi, Viet Nam;Ministry of Agriculture and Rural Development, Hanoi, Viet Nam;World Health Organization, Country Office, Hanoi, Viet Nam;Bach Mai Hospital, Hanoi, Viet Nam;Nuffield Department of Medicine, Centre for Tropical Medicine, University of Oxford, Oxford, UK;National Hospital of Tropical Diseases, Hanoi, Viet Nam

关键词: Antibiotic consumption;    Resource constrained;    Legislation (health);    Health systems;    Health policy;    Bacterial diseases;    Antibiotic resistance;   

Others  :  1161467
DOI  :  10.1186/1471-2458-13-1158

 received in 2013-04-19, accepted in 2013-11-22,  发布年份 2013

【 摘 要 】

Background

Antimicrobial resistance is a major contemporary public health threat. Strategies to contain antimicrobial resistance have been comprehensively set forth, however in developing countries where the need for effective antimicrobials is greatest implementation has proved problematic. A better understanding of patterns and determinants of antibiotic use and resistance in emerging economies may permit more appropriately targeted interventions.

Viet Nam, with a large population, high burden of infectious disease and relatively unrestricted access to medication, is an excellent case study of the difficulties faced by emerging economies in controlling antimicrobial resistance.

Methods

Our working group conducted a situation analysis of the current patterns and determinants of antibiotic use and resistance in Viet Nam. International publications and local reports published between 1-1-1990 and 31-8-2012 were reviewed. All stakeholders analyzed the findings at a policy workshop and feasible recommendations were suggested to improve antibiotic use in Viet Nam.

Here we report the results of our situation analysis focusing on: the healthcare system, drug regulation and supply; antibiotic resistance and infection control; and agricultural antibiotic use.

Results

Market reforms have improved healthcare access in Viet Nam and contributed to better health outcomes. However, increased accessibility has been accompanied by injudicious antibiotic use in hospitals and the community, with predictable escalation in bacterial resistance. Prescribing practices are poor and self-medication is common – often being the most affordable way to access healthcare. Many policies exist to regulate antibiotic use but enforcement is insufficient or lacking.

Pneumococcal penicillin-resistance rates are the highest in Asia and carbapenem-resistant bacteria (notably NDM-1) have recently emerged. Hospital acquired infections, predominantly with multi-drug resistant Gram-negative organisms, place additional strain on limited resources. Widespread agricultural antibiotic use further propagates antimicrobial resistance.

Conclusions

Future legislation regarding antibiotic access must alter incentives for purchasers and providers and ensure effective enforcement. The Ministry of Health recently initiated a national action plan and approved a multicenter health improvement project to strengthen national capacity for antimicrobial stewardship in Viet Nam. This analysis provided important input to these initiatives. Our methodologies and findings may be of use to others across the world tackling the growing threat of antibiotic resistance.

【 授权许可】

   
2013 Nguyen et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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