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Quang Vo T, Vinh Tran Q, Phuong Ngoc Ta A, Thanh Nguyen B, Nguyen Thanh Phan V, Ho Nguyen Anh T, Nguyen Khanh Huynh T. The influence of attributes on community preferences regarding antibiotic treatment: evidence from a discrete choice model. PSYCHOL HEALTH MED 2024:1-18. [PMID: 38700271 DOI: 10.1080/13548506.2024.2342589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 04/02/2024] [Indexed: 05/05/2024]
Abstract
Antibiotic resistance (AR) rates in Vietnam are among the highest in Asia, and recent infections due to multi-drug resistance in the country have caused thousands of deaths each year. This study investigated a Vietnamese community's preferences for antibiotic treatment and its knowledge and attitudes regarding antibiotics. A discrete choice experiment-based survey was developed and administered to the population of interest. The respondents were given sociodemographic-, knowledge- and attitude-related items and 17 pairs of choice tasks. Two hypothetical options were included in each choice task. Latent class analysis was conducted to determine the differences among the respondents' preferences. Among 1,014 respondents, 805 (79.4%) gave valid questionnaires. A three-latent-class model with four covariates (age, healthcare-related education or career, occupation, and attitude classifications) was used in the analysis. All five attributes significantly influenced the respondents' decisions. The majority, including young employed respondents with non-healthcare-related work or education, found treatment failure more important. Older respondents who had healthcare-related education/careers and/or appropriate antibiotic use- and antibiotics resistance-related attitudes, regarded contribution to antibiotic resistance as an important attribute in selecting antibiotic treatments. Unemployed individuals with correct knowledge identified the cost of antibiotic treatment as the most essential decision-making factor. Findings suggest minimal antibiotic impact on resistance; only 7.83% view it as amajor concern. The respondents exhibited substantial preference heterogeneity, and the general Vietnamese public had poor knowledge of and attitudes toward antibiotic use and antibiotic resistance. This study emphasizes the need for individual responsibility for antibiotic resistance and appropriate antibiotic use.
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Affiliation(s)
- Trung Quang Vo
- Department of Economic and Administrative Pharmacy (EAP), Faculty of Pharmacy, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Quang Vinh Tran
- Department of Economic and Administrative Pharmacy (EAP), Faculty of Pharmacy, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Anh Phuong Ngoc Ta
- Department of Economic and Administrative Pharmacy (EAP), Faculty of Pharmacy, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Binh Thanh Nguyen
- Faculty of Pharmaceutical Management and Economics, Hanoi University of Pharmacy, Hanoi, Vietnam
| | - Van Nguyen Thanh Phan
- Faculty of Medicine, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Tuan Ho Nguyen Anh
- Faculty of Medicine, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
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Hoang ATP, Do MC, Kim KW. Environmental risk assessment of selected pharmaceuticals in hospital wastewater in nothern Vietnam. CHEMOSPHERE 2024; 356:141973. [PMID: 38608777 DOI: 10.1016/j.chemosphere.2024.141973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 04/06/2024] [Accepted: 04/09/2024] [Indexed: 04/14/2024]
Abstract
Pharmaceuticals are progressively employed in both human and veterinary medicine and increasingly recognized as environmental contaminants. This study investigated the occurrence of selected pharmaceuticals in influent and effluent of wastewater treatment plants of 12 hospitals in Hanoi and 3 northern cities of Vietnam during dry and rainy seasons. In addition, environmental risk of pharmaceuticals in both hospital influents and effluents were evaluated based on risk quotients (RQs). Nine selected pharmaceutical compounds including sulfamethoxazole (SMX), naproxen (NPX), diclofenac (DCF), ibuprofen (IBU), acetaminophen (ACT), carbamazepine (CBM), iopromide (IOP), atenolol (ATN), and caffeine (CAF) were frequently detected in most influent and effluent wastewaters of 12 investigated hospitals. Detected compound levels exhibited a wide range, from as low as 1 ng/L for DCF to as high as 61,772 ng/L for ACT. Among these compounds, ACT, CAF, SMX, and IOP were consistently detected at substantial concentrations in both influents and effluents. This investigation also highlighted potential risks posed by SMX, ACT, and CAF residues present in influents and effluents of hospital wastewater treatment plants (WWTPs) to aquatic ecosystem. These finding are expected to provide scientific-based evidence for the development of hospital waste management and environmental management programs in Vietnam.
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Affiliation(s)
- Anh T P Hoang
- School of Earth Sciences and Environmental Engineering, Gwangju Institute of Science and Technology, 61005, Gwangju, South Korea
| | - Manh Cuong Do
- Health Environment Management Agency, Ministry of Health, 12014, Hanoi, Viet Nam
| | - Kyoung-Woong Kim
- School of Earth Sciences and Environmental Engineering, Gwangju Institute of Science and Technology, 61005, Gwangju, South Korea.
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Thomas SA, Mathew P, Ranjalkar J, Nguyen TBV, Giao VTQ, Chandy SJ. Public perception and community-level impact of national action plans on antimicrobial resistance in Vietnam. JAC Antimicrob Resist 2024; 6:dlad146. [PMID: 38161968 PMCID: PMC10753920 DOI: 10.1093/jacamr/dlad146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 12/05/2023] [Indexed: 01/03/2024] Open
Abstract
Objectives Vietnam was the first country from the WHO Western Pacific Region to adopt a national action plan (NAP) on antimicrobial resistance (AMR) in 2013. The multilayered nature of AMR requires coordination across 'One Health' sectors, dedicated financing, multistakeholder involvement, and widespread community engagement to implement the action plans. This study explores the perceived impact of NAP implementation at the community level. Methods Key informant interviews (KIIs) were used for data collection during 2021. An interview tool was used for the KIIs and purposive sampling was used to identify study participants from Vietnam. The study participants were those engaged with a substantial scale of antimicrobial usage, diagnosis of infections or concerned with antimicrobial content in effluents in their professional life. Twelve KIIs were conducted with participants from human health, animal health and the environmental sector. The data were entered into Microsoft Excel, and manifest and latent content analysis was done. Results The analysis highlighted themes such as limited public awareness of AMR, ongoing capacity building and quality assurance initiatives, implementation of guidelines and regulations for AMR containment, sustained investment in improving infrastructure, and challenges relating to accountability whilst prescribing and selling antibiotics. Conclusions There were many positive critical developments during the NAP implementation period in Vietnam towards AMR mitigation. For better impact, there is a need to revitalize the implementation machinery of NAPs by improving the enforcement capacity of regulations, cross-sectoral collaboration and promoting community ownership.
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Affiliation(s)
| | - Philip Mathew
- ReAct Asia Pacific, Christian Medical College, Vellore, Tamil Nadu, India
| | - Jaya Ranjalkar
- ReAct Asia Pacific, Christian Medical College, Vellore, Tamil Nadu, India
| | | | | | - Sujith J Chandy
- Department of Pharmacology & Clinical Pharmacology, Christian Medical College, Vellore, Tamil Nadu, India
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Nguyen TC, Le GKN, Pham DTH, Pham BV, Nguyen LTH, Che TH, Nguyen HT, Truong DQ, Robert A, Bontems P, Nguyen PNV. Antibiotic resistance and heteroresistance in Helicobacter pylori isolates from symptomatic Vietnamese children: A prospective multicenter study. Helicobacter 2023; 28:e13009. [PMID: 37497797 DOI: 10.1111/hel.13009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 06/26/2023] [Accepted: 07/19/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND Antibiotic resistance of Helicobacter pylori (H. pylori) is increasing worldwide, with geographical variations, impacting the treatment outcomes. This study assessed the antibiotic resistance patterns of H. pylori in Vietnamese children. MATERIALS AND METHODS Symptomatic children undergoing gastroduodenoscopy at two tertiary Children's Hospitals in Ho Chi Minh City were recruited. Antral and corpus biopsies were obtained and cultured separately. Susceptibility to amoxicillin (AMO), clarithromycin (CLA), metronidazole (MET), levofloxacin (LEV), and tetracycline (TET) was determined using E-test. Polymerase chain reaction was performed on another antral biopsy to detect the urease gene, cytotoxin-associated gene A (cagA), vacuolating cytotoxin A (vacA) genotypes, and 23S rRNA mutations conferring CLA resistance. RESULTS Among 123 enrolled children, a high primary resistance rate was found for CLA (68.5%, 61/89), followed by LEV (55.1%), MET (31.5%), AMO (25.8%), and TET (1.1%). Secondary resistance rates were 82.1% (7/28), 71.4%, 53.6%, and 3.6% for CLA, LEV, MET, and TET, respectively. Multidrug resistance was frequent (67.7%), with common patterns including CLA + LEV (20.3%) and CLA + MTZ + LEV (15.2%). Heteroresistance was detected in eight children (6.5%). The A2143G mutation was detected in 97.5% (119/122) of children. 86.1% of children had positive cagA strains and 27.9% had multiple vacA genotypes. No factor was significantly associated with antibiotic resistance. CONCLUSIONS The alarming rate of antibiotic resistance for H. pylori, especially for CLA, with emerging multi- and hetero-resistant strains, pose a major treatment challenge that precludes CLA use as empirical therapy. Biopsies from both antrum and corpus can improve H. pylori culture, allowing tailored treatment based on antimicrobial susceptibility.
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Affiliation(s)
- Tu Cam Nguyen
- Department of Gastroenterology, City Children's Hospital, Ho Chi Minh City, Vietnam
- Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Giao Kim Ngoc Le
- Department of Microbiology and Parasitology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Dao Thi Hong Pham
- Department of Genetics, University of Science - Vietnam National University Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Bao Van Pham
- Department of Microbiology and Parasitology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Loan Thi Hong Nguyen
- Department of Gastroenterology, Children's Hospital 2, Ho Chi Minh City, Vietnam
| | - Thai Hoang Che
- Department of Biostatistics and Informatics, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Hiep Thanh Nguyen
- Faculty of Public Health, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Dinh Quang Truong
- Department of Surgery, City Children's Hospital, Ho Chi Minh City, Vietnam
| | - Annie Robert
- Institut de recherche expérimentale et clinique, Pôle d'épidémiologie et Biostatistique, Université catholique de Louvain, Brussels, Belgium
| | - Patrick Bontems
- Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium
- Department of Gastroenterology, Hôpital Universitaire des Enfants Reine Fabiola, Brussels, Belgium
| | - Phuong Ngoc Van Nguyen
- Department of Biostatistics and Informatics, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
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Zhang T, Lin H, Zhao X, Wang W, Yan F, Lambert H. Influences on treatment-seeking and antibiotic use for common illnesses in eastern China. BMC Public Health 2023; 23:1849. [PMID: 37740203 PMCID: PMC10517519 DOI: 10.1186/s12889-023-16700-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 09/04/2023] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND Antibiotic resistance rates remain high in China where antibiotics are widely used for common illnesses. This study aimed to investigate the influences on people's decisions on treatment and antibiotic use for common illnesses in eastern China. METHODS Semi-structured interviews were conducted with 29 patients recruited through convenience sampling between July 2020 and January 2021 in one hospital in County A in Zhejiang Province, and one hospital and one village clinic in County B in Jiangsu Province, respectively. All interviews were audio-recorded, transcribed verbatim and thematically analysed. This study is nested in a larger interdisciplinary mixed method project and we also compared our qualitative findings with quantitative results from a household survey conducted as part of this wider project. RESULTS Participants' decisions about treatment-seeking and antibiotic use for common illnesses were found to be influenced by four interactive domains. (i) Self-evaluation of illness severity: Participants tend to self-treat minor conditions with ordinary medicines first and do not resort to antibiotics unless the condition worsens or is considered inflammation- related. Visiting healthcare facilities is seen as the final option. (ii) Access to and trust in care: These treatment-seeking practices are also associated with the perception, in contrast with retail pharmacies, hospitals provide professional and trustworthy care but are difficult to access, and hence require visiting only for severe illness. (iii) Prior experience: previous medical treatment and experiences of self-medication also influence participants' treatment decisions including the use of antibiotics. (iv) Medication characteristics: Participants view antibiotics as powerful medicines with harms and risks, requiring consumers to carefully trade off benefits and harms before use. CONCLUSIONS People's treatment decisions in relation to antibiotic use in eastern China are influenced by an interplay of lay conceptual models of illnesses and antibiotics and broader organisational, social, and contextual factors. Interventions focusing on individual education to incorporate biomedical knowledge into lay understandings, and reducing situational and social incentives for self-medicating with antibiotics by strengthening access to quality professional care, would be helpful in promoting antibiotic stewardship.
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Affiliation(s)
- Tingting Zhang
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Hanyi Lin
- Department of Social Medicine, School of Public Health, Fudan University, Shanghai, China
- Key Laboratory of Health Technology Assessment of National Health Commission, School of Public Health, Fudan University, Shanghai, China
| | - Xinping Zhao
- Department of Social Medicine, School of Public Health, Fudan University, Shanghai, China
- Key Laboratory of Health Technology Assessment of National Health Commission, School of Public Health, Fudan University, Shanghai, China
| | - Wei Wang
- Department of Social Medicine, School of Public Health, Fudan University, Shanghai, China
- Key Laboratory of Health Technology Assessment of National Health Commission, School of Public Health, Fudan University, Shanghai, China
| | - Fei Yan
- Department of Social Medicine, School of Public Health, Fudan University, Shanghai, China.
- Key Laboratory of Health Technology Assessment of National Health Commission, School of Public Health, Fudan University, Shanghai, China.
| | - Helen Lambert
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
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Keenan K, Fredricks KJ, Al Ahad MA, Neema S, Mwanga JR, Kesby M, Mushi MF, Aduda A, Green DL, Lynch AG, Huque SI, Mmbaga BT, Worthington H, Kansiime C, Olamijuwon E, Ntinginya NE, Loza O, Bazira J, Maldonado-Barragán A, Smith VA, Decano AG, Njeru JM, Sandeman A, Stelling J, Elliott A, Aanensen D, Gillespie SH, Kibiki G, Sabiiti W, Sloan DJ, Asiimwe BB, Kiiru J, Mshana SE, Holden MTG. Unravelling patient pathways in the context of antibacterial resistance in East Africa. BMC Infect Dis 2023; 23:414. [PMID: 37337134 PMCID: PMC10278291 DOI: 10.1186/s12879-023-08392-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 06/09/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND A key factor driving the development and maintenance of antibacterial resistance (ABR) is individuals' use of antibiotics (ABs) to treat illness. To better understand motivations and context for antibiotic use we use the concept of a patient treatment-seeking pathway: a treatment journey encompassing where patients go when they are unwell, what motivates their choices, and how they obtain antibiotics. This paper investigates patterns and determinants of patient treatment-seeking pathways, and how they intersect with AB use in East Africa, a region where ABR-attributable deaths are exceptionally high. METHODS The Holistic Approach to Unravelling Antibacterial Resistance (HATUA) Consortium collected quantitative data from 6,827 adult outpatients presenting with urinary tract infection (UTI) symptoms in Kenya, Tanzania, and Uganda between February 2019- September 2020, and conducted qualitative in-depth patient interviews with a subset (n = 116). We described patterns of treatment-seeking visually using Sankey plots and explored explanations and motivations using mixed-methods. Using Bayesian hierarchical regression modelling, we investigated the associations between socio-demographic, economic, healthcare, and attitudinal factors and three factors related to ABR: self-treatment as a first step, having a multi-step treatment pathway, and consuming ABs. RESULTS Although most patients (86%) sought help from medical facilities in the first instance, many (56%) described multi-step, repetitive treatment-seeking pathways, which further increased the likelihood of consuming ABs. Higher socio-economic status patients were more likely to consume ABs and have multi-step pathways. Reasons for choosing providers (e.g., cost, location, time) were conditioned by wider structural factors such as hybrid healthcare systems and AB availability. CONCLUSION There is likely to be a reinforcing cycle between complex, repetitive treatment pathways, AB consumption and ABR. A focus on individual antibiotic use as the key intervention point in this cycle ignores the contextual challenges patients face when treatment seeking, which include inadequate access to diagnostics, perceived inefficient public healthcare and ease of purchasing antibiotics without prescription. Pluralistic healthcare landscapes may promote more complex treatment seeking and therefore inappropriate AB use. We recommend further attention to healthcare system factors, focussing on medical facilities (e.g., accessible diagnostics, patient-doctor interactions, information flows), and community AB access points (e.g., drug sellers).
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Affiliation(s)
- Katherine Keenan
- School of Geography and Sustainable Development, University of St. Andrews, St Andrews, KY16 9AL, UK.
| | - Kathryn J Fredricks
- School of Geography and Sustainable Development, University of St. Andrews, St Andrews, KY16 9AL, UK
| | - Mary Abed Al Ahad
- School of Geography and Sustainable Development, University of St. Andrews, St Andrews, KY16 9AL, UK
| | | | - Joseph R Mwanga
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Mike Kesby
- School of Geography and Sustainable Development, University of St. Andrews, St Andrews, KY16 9AL, UK
| | - Martha F Mushi
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | | | - Dominique L Green
- School of Geography and Sustainable Development, University of St. Andrews, St Andrews, KY16 9AL, UK
| | - Andy G Lynch
- School of Geography and Sustainable Development, University of St. Andrews, St Andrews, KY16 9AL, UK
| | - Sarah I Huque
- School of Geography and Sustainable Development, University of St. Andrews, St Andrews, KY16 9AL, UK
| | - Blandina T Mmbaga
- Kilimanjaro Clinical Research Institute and Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Hannah Worthington
- School of Geography and Sustainable Development, University of St. Andrews, St Andrews, KY16 9AL, UK
| | | | - Emmanuel Olamijuwon
- School of Geography and Sustainable Development, University of St. Andrews, St Andrews, KY16 9AL, UK
| | | | - Olga Loza
- School of Geography and Sustainable Development, University of St. Andrews, St Andrews, KY16 9AL, UK
| | | | | | - VAnne Smith
- School of Geography and Sustainable Development, University of St. Andrews, St Andrews, KY16 9AL, UK
| | - Arun Gonzales Decano
- School of Geography and Sustainable Development, University of St. Andrews, St Andrews, KY16 9AL, UK
| | | | - Alison Sandeman
- School of Geography and Sustainable Development, University of St. Andrews, St Andrews, KY16 9AL, UK
| | | | - Alison Elliott
- London School of Hygiene & Tropical Medicine, London, UK
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Institute, Entebbe, Uganda
| | | | - Stephen H Gillespie
- School of Geography and Sustainable Development, University of St. Andrews, St Andrews, KY16 9AL, UK
| | | | - Wilber Sabiiti
- School of Geography and Sustainable Development, University of St. Andrews, St Andrews, KY16 9AL, UK
| | - Derek J Sloan
- School of Geography and Sustainable Development, University of St. Andrews, St Andrews, KY16 9AL, UK
| | | | - John Kiiru
- Kenya Medical Research Institute, Nairobi, Kenya
| | - Stephen E Mshana
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Matthew T G Holden
- School of Geography and Sustainable Development, University of St. Andrews, St Andrews, KY16 9AL, UK
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Svadzian A, Daniels B, Sulis G, Das J, Daftary A, Kwan A, Das V, Das R, Pai M. Use of standardised patients to assess tuberculosis case management by private pharmacies in Patna, India: A repeat cross-sectional study. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001898. [PMID: 37235550 DOI: 10.1371/journal.pgph.0001898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 04/18/2023] [Indexed: 05/28/2023]
Abstract
As the first point of care for many healthcare seekers, private pharmacies play an important role in tuberculosis (TB) care. However, previous studies in India have showed that private pharmacies commonly dispense symptomatic treatments and broad-spectrum antibiotics over-the-counter (OTC), rather than referring patients for TB testing. Such inappropriate management by pharmacies can delaye TB diagnosis. We assessed medical advice and OTC drug dispensing practices of pharmacists for standardized patients presenting with classic symptoms of pulmonary TB (case 1) and for those with sputum smear positive pulmonary TB (case 2), and examined how practices have changed over time in an urban Indian site. We examined how and whether private pharmacies improved practices for TB in 2019 compared to a baseline study conducted in 2015 in the city of Patna, using the same survey sampling techniques and study staff. The proportion of patient-pharmacist interactions that resulted in correct or ideal management, as well as the proportion of interactions resulting in antibiotic, quinolone, and corticosteroid are presented, with standard errors clustered at the provider level. To assess the difference in case management and the use of drugs across the two cases by round, a difference in difference (DiD) model was employed. A total of 936 SP interactions were completed over both rounds of survey. Our results indicate that across both rounds of data collection, 331 of 936 (35%; 95% CI: 32-38%) of interactions were correctly managed. At baseline, 215 of 500 (43%; 95% CI: 39-47%) of interactions were correctly managed whereas 116 of 436 (27%; 95% CI: 23-31%) were correctly managed in the second round of data collection. Ideal management, where in addition to a referral, patients were not prescribed any potentially harmful medications, was seen in 275 of 936 (29%; 95% CI: 27-32%) of interactions overall, with 194 of 500 (39%; 95% CI: 35-43%) of interactions at baseline and 81 of 436 (19%; 95% CI: 15-22%) in round 2. No private pharmacy dispensed anti-TB medications without a prescription. On average, the difference in correct case management between case 1 vs. case 2 dropped by 20 percent points from baseline to the second round of data collection. Similarly, ideal case management decreased by 26 percentage points between rounds. This is in contrast with the dispensation of medicines, which had the opposite effect between rounds; the difference in dispensation of quinolones between case 1 and case 2 increased by 14 percentage points, as did corticosteroids by 9 percentage points, antibiotics by 25 percentage points and medicines generally by 30 percentage points. Our standardised patient study provides valuable insights into how private pharmacies in an Indian city changed their management of patients with TB symptoms or with confirmed TB over a 5-year period. We saw that overall, private pharmacy performance has weakened over time. However, no OTC dispensation of anti-TB medications occurred in either survey round. As the first point of contact for many care seekers, continued and sustained efforts to engage with Indian private pharmacies should be prioritized.
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Affiliation(s)
- Anita Svadzian
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
- McGill International TB Centre, McGill University, Montreal, Quebec, Canada
| | | | - Giorgia Sulis
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Jishnu Das
- Georgetown University, Washington, DC, United States of America
- Centre for Policy Research, New Delhi, India
| | - Amrita Daftary
- Dahdaleh Institute of Global Health Research, School of Global Health, York University, Toronto, Ontario, Canada
- Centre for the Aids Programme of Research in South Africa MRC-HIV-TB Pathogenesis and Treatment Research Unit, Durban, South Africa
| | - Ada Kwan
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California, United States of America
| | - Veena Das
- Department of Anthropology, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Ranendra Das
- Institute for Socio-Economic Research on Development and Democracy, Delhi, India
| | - Madhukar Pai
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
- McGill International TB Centre, McGill University, Montreal, Quebec, Canada
- Manipal McGill Program for Infectious Diseases, Manipal Centre for Infectious Diseases, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Nguyen PTN, Le NV, Dinh HMN, Nguyen BQP, Nguyen TVA. Lung penetration and pneumococcal target binding of antibiotics in lower respiratory tract infection. Curr Med Res Opin 2022; 38:2085-2095. [PMID: 36189961 DOI: 10.1080/03007995.2022.2131304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To achieve the therapeutic effects, antibiotics must penetrate rapidly into infection sites and bind to targets. This study reviewed updated knowledge on the ability of antibiotics to penetrate into the lung, their physicochemical properties influencing the pulmonary penetration and their ability to bind to targets on pneumococci. METHODS A search strategy was developed using PubMED, Web of Science, and ChEMBL. Data on serum protein binding, drug concentration, target binding ability, drug transporters, lung penetration, physicochemical properties of antibiotics in low respiratory tract infection (LRTI) were collected. RESULTS It was seen that infection site-to-serum concentration ratios of most antibiotics are >1 at different time points except for ceftriaxone, clindamycin and vancomycin. Most agents have proper physicochemical properties that facilitate antibiotic penetration. In antimicrobial-resistant Streptococcus pneumoniae, the binding affinity of antibiotics to targets mostly decreases compared to that in susceptible strains. The data on binding affinity of linezolid, clindamycin and vancomycin were insufficient. The higher drug concentration at the infection sites compared to that in the blood can be associated with inflammation conditions. Little evidence showed the effect of drug transporters on the clinical efficacy of antibiotics against LRTI. CONCLUSIONS Data on antibiotic penetration into the lung in LRTI patients and binding affinity of antibiotics for pneumococcal targets are still limited. Further studies are required to clarify the associations of the lung penetration and target binding ability of antibitotics with therapeutic efficacy to help propose the right antibiotics for LRTI.
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Affiliation(s)
| | - Nho Van Le
- Danang University of Medical Technology and Pharmacy, Da Nang, Vietnam
| | | | | | - Thi Van Anh Nguyen
- Department of Life Sciences, University of Science and Technology of Hanoi (USTH), Vietnam Academy of Science and Technology (VAST), Hanoi, Vietnam
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Torumkuney D, Kundu S, Vu GV, Nguyen HA, Pham HV, Kamble P, Truong Ha Lan N, Keles N. Country data on AMR in Vietnam in the context of community-acquired respiratory tract infections: links between antibiotic susceptibility, local and international antibiotic prescribing guidelines, access to medicines and clinical outcome. J Antimicrob Chemother 2022; 77:i26-i34. [PMID: 36065731 PMCID: PMC9445855 DOI: 10.1093/jac/dkac214] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Antimicrobial resistance (AMR) is one of the biggest threats to global public health. Selection of resistant bacteria is driven by inappropriate use of antibiotics, amongst other factors. COVID-19 may have exacerbated AMR due to unnecessary antibiotic prescribing. Country-level knowledge is needed to understand options for action. Objectives To review the current situation with respect to AMR in Vietnam and initiatives addressing it. Identifying areas where more information is required will provide a call to action to minimize any further rises in AMR within Vietnam and improve patient outcomes. Methods National initiatives to address AMR in Vietnam, antibiotic use and prescribing, and availability of susceptibility data, in particular for the key community-acquired respiratory tract infection (CA-RTI) pathogens Streptococcus pneumoniae and Haemophilus influenzae, were identified. National and international antibiotic prescribing guidelines for CA-RTIs (community-acquired pneumonia, acute otitis media and acute bacterial rhinosinusitis) commonly used locally were also reviewed, plus local antibiotic availability. Insights from clinicians in Vietnam were sought to contextualize this information. Conclusions In Vietnam there have been some initiatives addressing AMR; Vietnam was the first country in the Western Pacific Region to develop a national action plan to combat AMR, which according to the WHO is being implemented. Vietnam also has one of the highest rates of AMR in Asia due, in part, to the overuse of antimicrobial drugs, both in the animal health sector and in humans in both hospitals and the community. In addition, despite a 2005 law requiring antibiotic prescription, there is unrestricted access to over-the-counter antibiotics. Several global surveillance studies provide antibiotic susceptibility data for CA-RTI pathogens in Vietnam including Survey of Antibiotic Resistance (SOAR) and SENTRY (small isolate numbers only). For management of the common CA-RTIs in Vietnam there are several country-specific local antibiotic prescribing guidelines and in addition, there is a range of international guidelines referred to, but these may have been created based on pathogen resistance patterns that might be very different to those in Vietnam. Expert clinician opinion confirms the high resistance rates among common respiratory pathogens. A more standardized inclusive approach in developing local guidelines, using up-to-date surveillance data of isolates from community-acquired infections in Vietnam, could make management guideline use more locally relevant for clinicians. This would pave the way for a higher level of appropriate antibiotic prescribing and improved adherence. This would, in turn, potentially limit AMR development and improve clinical outcomes for patients.
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Affiliation(s)
- Didem Torumkuney
- GlaxoSmithKline, 980 Great West Road, Brentford, Middlesex TW8 9GS, UK
| | | | - Giap Van Vu
- Respiratory Center, Bach Mai Hospital, Hanoi 100000, Vietnam
| | - Hoang Anh Nguyen
- The National Centre for Drug Information and Adverse Drug Reactions Monitoring, Hanoi University of Pharmacy, Hanoi, Vietnam
| | - Hung Van Pham
- University of Medicine and Pharmacy, 217 Hong Bang Street, Ward 11, District 5, Ho Chi Minh City, Vietnam
| | - Praveen Kamble
- GlaxoSmithKline, 252, Dr Annie Besant Road, Worli, 400030 Mumbai, India
| | - Ngoc Truong Ha Lan
- GlaxoSmithKline Vietnam, Unit 701, 235 Dong Khoi, District 1, Ho Chi Minh City, Vietnam
| | - Nergis Keles
- GlaxoSmithKline, Büyükdere Cad. No: 173, 1. Levent Plaza B Blok 34394 Levent, Istanbul, Türkiye
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10
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Characterisation of chicken farms in Vietnam: a typology of antimicrobial use among different production systems. Prev Vet Med 2022; 208:105731. [DOI: 10.1016/j.prevetmed.2022.105731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 07/08/2022] [Accepted: 07/26/2022] [Indexed: 11/22/2022]
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11
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Caudell M, Mangesho PE, Mwakapeje ER, Dorado-García A, Kabali E, Price C, OleNeselle M, Kimani T, Fasina FO. Narratives of veterinary drug use in northern Tanzania and consequences for drug stewardship strategies in low-income and middle-income countries. BMJ Glob Health 2022; 7:bmjgh-2021-006958. [PMID: 35058305 PMCID: PMC8772431 DOI: 10.1136/bmjgh-2021-006958] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 01/03/2022] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Awareness-raising campaigns play a central role in efforts to combat drug resistance. These campaigns assume that knowledge deficits drive poor practices that increase resistance. Therefore, increasing awareness will promote prudent practices and reduce resistance. However, most awareness campaigns have been developed and evaluated in high-income and public health settings. Consequently, it is not clear whether these campaigns are effective in low-income and middle-income countries and/or within animal health settings. METHODS Focus group discussions and in-depth interviews were used to collect narratives of veterinary drug use among Maasai pastoralists (n=70), animal health professionals (n=10) and veterinary drug sellers (n=5). Thematic analysis was used to identify recurring themes across narratives and groups. RESULTS Narratives of Maasai and animal health professionals indicated that Maasai treated their livestock with limited input from the professional sector and that non-prudent treatment practices were observed (eg, using antimicrobials as 'energizers'). Professionals linked these practices to knowledge and attitudinal deficits among the Maasai, while Maasai narratives highlighted the importance of climatic uncertainties and cultural beliefs surrounding veterinary care. CONCLUSION Narratives of veterinary drug use from animal health professionals are consistent with the knowledge deficit assumption guiding awareness-raising efforts. In contrast, Maasai narratives highlight how animal health practices are patterned by cultural norms interacting with factors largely outside of Maasai control, including a constrained professional veterinary sector. If these cultural and structural contexts remain unconsidered in awareness-raising strategies, current campaigns are unlikely to motivate practices necessary to limit drug resistance, especially within low-income and middle-income settings.
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Affiliation(s)
- Mark Caudell
- Food and Agriculture Organization of the United Nations, Nairobi, Kenya
| | - Peter E Mangesho
- National Institute for Medical Research, Muheza, Tanzania, United Republic of
| | - Elibariki R Mwakapeje
- Food and Agriculture Organization of the United Nations, Dar es Salaam, Tanzania, United Republic of
| | | | - Emmanuel Kabali
- Food and Agriculture Organization of the United Nations, Rome, Italy
| | - Cortney Price
- Food and Agriculture Organization of the United Nations, Rome, Italy
| | - Moses OleNeselle
- Food and Agriculture Organization of the United Nations, Dar es Salaam, Tanzania, United Republic of
| | - Tabitha Kimani
- Food and Agriculture Organization of the United Nations, Nairobi, Kenya
| | - Folorunso O Fasina
- Food and Agriculture Organization of the United Nations, Dar es Salaam, Tanzania, United Republic of
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12
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Zawahir S, Le H, Nguyen TA, Beardsley J, Duc AD, Bernays S, Viney K, Cao Hung T, McKinn S, Tran HH, Nguyen Tu S, Velen K, Luong Minh T, Tran Thi Mai H, Nguyen Viet N, Nguyen Viet H, Nguyen Thi Cam V, Nguyen Trung T, Jan S, Marais BJ, Negin J, Marks GB, Fox G. Standardised patient study to assess tuberculosis case detection within the private pharmacy sector in Vietnam. BMJ Glob Health 2021; 6:bmjgh-2021-006475. [PMID: 34615661 PMCID: PMC8496389 DOI: 10.1136/bmjgh-2021-006475] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 09/17/2021] [Indexed: 11/25/2022] Open
Abstract
Background Of the estimated 10 million people affected by (TB) each year, one-third are never diagnosed. Delayed case detection within the private healthcare sector has been identified as a particular problem in some settings, leading to considerable morbidity, mortality and community transmission. Using unannounced standardised patient (SP) visits to the pharmacies, we aimed to evaluate the performance of private pharmacies in the detection and treatment of TB. Methods A cross-sectional study was undertaken at randomly selected private pharmacies within 40 districts of Vietnam. Trained actors implemented two standardised clinical scenarios of presumptive TB and presumptive multidrug-resistant TB (MDR-TB). Outcomes were the proportion of SPs referred for medical assessment and the proportion inappropriately receiving broad-spectrum antibiotics. Logistic regression evaluated predictors of SPs’ referral. Results In total, 638 SP encounters were conducted, of which only 155 (24.3%) were referred for medical assessment; 511 (80·1%) were inappropriately offered antibiotics. A higher proportion of SPs were referred without having been given antibiotics if they had presumptive MDR-TB (68/320, 21.3%) versus presumptive TB (17/318, 5.3%; adjusted OR=4.8, 95% CI 2.9 to 7.8). Pharmacies offered antibiotics without a prescription to 89.9% of SPs with presumptive TB and 70.3% with presumptive MDR-TB, with no clear follow-up plan. Conclusions Few SPs with presumptive TB were appropriately referred for medical assessment by private pharmacies. Interventions to improve appropriate TB referral within the private pharmacy sector are urgently required to reduce the number of undiagnosed TB cases in Vietnam and similar high-prevalence settings.
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Affiliation(s)
- Shukry Zawahir
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Hien Le
- Woolcock Institute of Medical Research, Kim Ma, Hanoi, Vietnam
| | - Thu Anh Nguyen
- Woolcock Institute of Medical Research, Kim Ma, Hanoi, Vietnam
| | - Justin Beardsley
- The Marie Bashir Institute, Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia
| | - Anh Dang Duc
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Sarah Bernays
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Kerri Viney
- Centre of Global Health, Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden.,Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Thai Cao Hung
- Medical Service Administration, Government of Viet Nam Ministry of Health, Hanoi, Vietnam
| | - Shannon McKinn
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Hoang Huy Tran
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Son Nguyen Tu
- Clinical Pharmacy, Hanoi University of Pharmacy, Hanoi, Vietnam
| | - Kavindhran Velen
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Tan Luong Minh
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | | | | | - Ha Nguyen Viet
- Woolcock Institute of Medical Research, Kim Ma, Hanoi, Vietnam
| | | | | | - Stephen Jan
- The George Institute for Global Health, Newtown, New South Wales, Australia
| | - Ben J Marais
- Marie Bashir Institute for Infectious Diseases and Biosecurity and the Children's Hospital at Westmead, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Joel Negin
- Faculty of Medicne and Health, The University of Sydney School of Public Health, Sydney, New South Wales, Australia
| | - Guy B Marks
- South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia.,Woolcock Institute of Medical Research, Glebe, New South Wales, Australia
| | - Gregory Fox
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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