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2017 ; 6
(ä): 30
Nephropedia Template TP
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Pervasive antibiotic misuse in the Cambodian community: antibiotic-seeking
behaviour with unrestricted access
#MMPMID28352463
Om C
; Daily F
; Vlieghe E
; McLaughlin JC
; McLaws ML
Antimicrob Resist Infect Control
2017[]; 6
(ä): 30
PMID28352463
show ga
BACKGROUND: Antibiotic misuse is widespread in resource-limited countries such as
Cambodia where the burden of infectious diseases is high and access to
antibiotics is unrestricted. We explored healthcare seeking behaviour related to
obtaining antibiotics and drivers of antibiotic misuse in the Cambodian
community. METHODS: In-depth interviews were held with family members of patients
being admitted in hospitals and private pharmacies termed pharmacy attendants in
the catchment areas of the hospitals. Nurses who run community primary healthcare
centres located within the hospital catchment areas were invited to attend focus
group discussions. Nvivo version 10 was used to code and manage thematic data
analysis. RESULTS: We conducted individual interviews with 35 family members, 7
untrained pharmacy attendants and 3 trained pharmacists and 6 focus group
discussions with 30 nurses. Self-medication with a drug-cocktail was widespread
and included broad-spectrum antibiotics for mild illness. Unrestricted access to
antibiotics was facilitated by various community enablers including pharmacies or
drug outlets, nurse suppliers and unofficial village medical providers referred
to as "village Pett" whose healthcare training has historically been in the field
and not at university. These enablers supplied the community with various types
of antibiotics including broad spectrum fluoroquinolones and cephalosporins. When
treatment was perceived to be ineffective patients would prescriber-shop various
suppliers who would unfailingly provide them with antibiotics. The main driver of
the community's demand for antibiotics was a mistaken belief in the benefits of
antibiotics for a common cold, high temperature, pain, malaria and 'Roleak' which
includes a broad catch-all for perceived inflammatory conditions. For severe
illnesses, patients would attend a community healthcare centre, hospital, or when
their finances permitted, a private prescriber. CONCLUSIONS: Pervasive antibiotic
misuse was driven by a habitual supplier-seeking behaviour that was enabled by
unrestricted access and misconceptions about antibiotics for mild illnesses.
Unofficial suppliers must be stopped by supporting existing regulations with
tough new laws aimed at outlawing supplies outside registered pharmacies and
fining registered pharmacist/owners of these pharmacies for supplying antibiotics
without a prescription. Community primary healthcare centres must be strengthened
to become the frontline antibiotic prescribers in the community thereby enabling
the community's access to inexpensive and appropriate healthcare. Community-based
education program should target appropriate health-seeking pathways and the
serious consequences of antibiotic misuse.