Abstract
ObjectivesAntimicrobial-resistant infections are a major global health issue. Ease of antimicrobial access in developing countries is proposed to be a key driver of the antimicrobial resistance (AMR) epidemic despite a lack of community antimicrobial usage data.MethodsUsing a mixed-methods approach (geospatial mapping, simulated clients, healthcare utilization, longitudinal cohort) we assessed antimicrobial access in the community and quantified antimicrobial usage for childhood diarrhoea in an urban Vietnamese setting.ResultsThe study area had a pharmacy density of 15.7 pharmacies/km2 (a pharmacy for every 1316 people). Using a simulated client method at pharmacies within the area, we found that 8% (3/37) and 22% (8/37) of outlets sold antimicrobials for paediatric watery and mucoid diarrhoea, respectively. However, despite ease of pharmacy access, the majority of caregivers would choose to take their child to a healthcare facility, with 81% (319/396) and 88% (347/396) of responders selecting a specialized hospital as one of their top three preferences when seeking treatment for watery and mucoid diarrhoea, respectively. We calculated that at least 19% (2688/14427) of diarrhoea episodes in those aged 1 to <5 years would receive an antimicrobial annually; however, antimicrobial usage was almost 10 times greater in hospitals than in the community.ConclusionsOur data question the impact of community antimicrobial usage on AMR and highlight the need for better education and guidelines for all professionals with the authority to prescribe antimicrobials.
Highlights
Antimicrobial resistance (AMR) is magnified in low- and middle-income countries (LMICs) as antimicrobial access and usage, poor sanitation and limited access to clean water are amongst the principal drivers
Unrestricted access to low-cost antimicrobials combined with a high burden of infectious disease, limited diagnostic capacity and large urbanizing populations demanding better medical care has created a favourable environment for propagating antimicrobialresistant bacteria in LMICs
We considered that antimicrobial usage for diarrhoeal disease was dependent on the number of diarrhoeal episodes for which medical treatment was sought, and how likely antimicrobials were to be prescribed for diarrhoeal treatment
Summary
Antimicrobial resistance (AMR) is rapidly becoming a global public health issue. In the past decade, many of the key antimicrobials on which we have come to rely in human medicine are in the process of losing, or have already lost, their effectiveness in treating infections caused by bacterial pathogens. AMR is a complex scientific, political, economic and social issue, and developed countries are leading research efforts to tackle the problems, the greatest impact of AMR is currently being felt in low- and middle-income countries (LMICs). AMR is magnified in LMICs as antimicrobial access and usage, poor sanitation and limited access to clean water are amongst the principal drivers. AMR is magnified in LMICs as antimicrobial access and usage, poor sanitation and limited access to clean water are amongst the principal drivers. Unrestricted access to low-cost antimicrobials combined with a high burden of infectious disease, limited diagnostic capacity and large urbanizing populations demanding better medical care has created a favourable environment for propagating antimicrobialresistant bacteria in LMICs.. Antimicrobials are frequently used indiscriminately to treat common human diseases, of which diarrhoea is a major contributor.
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