Antibiotic resistance is of widespread concern and is particularly critical in developing countries, like Vietnam, where there is a higher burden of infectious disease. In these countries, the cost of new and improved antibiotics can be insurmountable, leading to the use of outdated and ineffective antibiotics. Furthermore, self-diagnosis and self-treatment can lead to antibiotic resistance and an increase in the prevalence of infectious disease. In concert, these effects have undoubtedly changed the health-care landscape of Vietnam.
A worrisome issue in Vietnam is the economic situation pertaining to the development, sale, and purchase of antibiotics. In 2013, the average per capita income was $1,910 per year and 8.4% of the roughly 91.7 million people living in Vietnam were living below the national poverty line. These poor economic conditions have led to patients, physicians, clinics, hospitals, and retailers becoming more concerned with saving money or making a profit rather than considering the negative impacts of their antibiotic use on others.
As a result, about 80% of antibiotics used in Vietnam are sold without a prescription which has led to a widespread problem of misuse of antibiotics.
Even though prescriptions are legally required, the lack of enforcement allows consumers to purchase a plethora of antibiotics at pharmacies or drug outlets without a prescription. Vietnamese citizens commonly self-diagnose illness with low accuracy, and then self-treat with over-the-counter antibiotics. Individuals are engaging in this practice because it is much cheaper and faster than seeing a professional. The self-treatment of illnesses is especially dangerous because using an ineffective or partially effective antibiotic can apply a strong selective pressure for antibiotic-resistant bacteria. Although clinicians on occasion may misprescribe their patients, they are much more informed and must control antibiotic dosing regimens to reverse this resistance trend.
In 1986, Vietnam imposed “doi moi” reforms, which were a series of economic reforms with the goal of creating a “socialist-oriented market economy.” These reforms have helped increase family income and life expectancy while decreasing childhood mortality rates and improving access to health care. Although these reforms seem beneficial at first, upon closer examination there are some faults. With increased access to health care comes an increased access to antibiotics, which in turn can lead to an increase in resistance to antibiotics when misused. Vietnam has a troubling prevalence of penicillin-resistant (71.4% of isolates) and erythromycin-resistant (92.1% of isolates)
Streptococcus pneumoniae, a common agent of respiratory infections. Between the early and late 1990s, penicillin-resistance in S. pneumoniae isolates increased by over 45%. Due to such high resistance rates, recommended treatment regimens are likely to be ineffective and jeopardize the overall success of antibiotic treatment.
Many organizations are aiming to enact regulations and procedures for controlling this issue of antibiotic resistance including the Global Antibiotic Resistance Partnership (GARP) in Vietnam, the American Society for Microbiology (ASM) and Vietnam’s Antimicrobial Resistance (AMR) National Action Plan. Some proposed policy options include enforcing the current law that antibiotics must be offered by prescription use only, establishing infection-control committees in hospitals, developing national testing centers to track antibiotic resistance, monitoring antibiotic use in hospitals, properly teaching and training professionals on antibiotic resistance and appropriate antibiotic use, and developing standardized treatment guidelines.
What can you do to help? Spread the word: antibiotic resistance isn’t just a threat to developing countries, it affects all of us. Educate yourself: following microbial resistance news and outbreaks is extremely beneficial to maintaining knowledge on this issue. Support research: The Community for Open Antimicrobial Drug Discovery (CO-ADD) accepts donations to aid in the discovery of new antibiotics used to combat the organisms resistant to current antibiotics. The Antibiotic Resistance Action Center (ARAC) at the Milken Institute of Public Health at George Washington University accepts donations to fund research, foster strategic communications, and impose policies pertaining to solutions for fighting antibiotic resistance. There’s no denying that antibiotic resistance is an ominous threat to mankind. A global effort is vital in order to preserve human prosperity. Do what you can to get involved in this fight against super-bugs!
by Dylan Campbell