Quantifying antimicrobial access and usage for paediatric diarrhoeal disease in an urban community setting in Asia.

Autor:	Thi Quynh Nhi L; The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.; University of Medicine and Pharmacy in Ho Chi Minh City, Ho Chi Minh City, Vietnam., de Alwis R; The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.; Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, Oxford, UK., Khanh Lam P; The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam., Nhon Hoa N; University of Medicine and Pharmacy in Ho Chi Minh City, Ho Chi Minh City, Vietnam., Minh Nhan N; University of Medicine and Pharmacy in Ho Chi Minh City, Ho Chi Minh City, Vietnam., Thi Tu Oanh L; University of Medicine and Pharmacy in Ho Chi Minh City, Ho Chi Minh City, Vietnam., Thanh Nam D; University of Medicine and Pharmacy in Ho Chi Minh City, Ho Chi Minh City, Vietnam., Nguyen Ngoc Han B; University of Medicine and Pharmacy in Ho Chi Minh City, Ho Chi Minh City, Vietnam., Thi Thuy Huyen H; University of Medicine and Pharmacy in Ho Chi Minh City, Ho Chi Minh City, Vietnam., Thi Tuyen D; University of Medicine and Pharmacy in Ho Chi Minh City, Ho Chi Minh City, Vietnam., Thuy Duong V; The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.; Children Hospital 1, Ho Chi Minh City, Vietnam., Lan Vi L; The Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam., Thi Thuy Tien B; Hung Vuong Hospital, Ho Chi Minh City, Vietnam., Thi Diem Tuyet H; Hung Vuong Hospital, Ho Chi Minh City, Vietnam., Hoang Nha L; Ho Chi Minh City Department of Health, Ho Chi Minh City, Vietnam., Thwaites GE; The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.; Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, Oxford, UK., Van Dung D; University of Medicine and Pharmacy in Ho Chi Minh City, Ho Chi Minh City, Vietnam., Baker S; The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.; Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, Oxford, UK.; The Department of Medicine, University of Cambridge, Cambridge, UK.
Jazyk:	angličtina
Zdroj:	The Journal of antimicrobial chemotherapy [J Antimicrob Chemother] 2018 Sep 01; Vol. 73 (9), pp. 2546-2554.
DOI:	10.1093/jac/dky231
Abstrakt:	Objectives: Antimicrobial-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. Methods: Using 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. Results: The 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. Conclusions: Our 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.
Databáze:	MEDLINE
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