Antibiotic sales in rural and urban pharmacies in northern Vietnam: an observational study

Abstract

BackgroundThe irrational overuse of antibiotics should be minimized as it drives the development of antibiotic resistance, but changing these practices is challenging. A better understanding is needed of practices and economic incentives for antibiotic dispensing in order to design effective interventions to reduce inappropriate antibiotic use. Here we report on both quantitative and qualitative aspects of antibiotic sales in private pharmacies in northern Vietnam.MethodA cross-sectional study was conducted in which all drug sales were observed and recorded for three consecutive days at thirty private pharmacies, 15 urban and 15 rural, in the Hanoi region in 2010. The proportion of antibiotics to total drug sales was assessed and the revenue was calculated for rural and urban settings. Pharmacists and drug sellers were interviewed by a semi-structured questionnaire and in-depth interviews to understand the incentive structure of antibiotic dispensing.ResultsIn total 2953 drug sale transactions (2083 urban and 870 rural) were observed. Antibiotics contributed 24% and 18% to the total revenue of pharmacies in urban and rural, respectively. Most antibiotics were sold without a prescription: 88% in urban and 91% in rural pharmacies. The most frequent reported reason for buying antibiotics was cough in the urban setting (32%) and fever in the rural area (22%). Consumers commonly requested antibiotics without having a prescription: 50% in urban and 28% in rural area. The qualitative data revealed that drug sellers and customer’s knowledge of antibiotics and antibiotic resistance were low, particularly in rural area.ConclusionOver the counter sales of antibiotic without a prescription remains a major problem in Vietnam. Suggested areas of improvement are enforcement of regulations and pricing policies and educational programs to increase the knowledge of drug sellers as well as to increase community awareness to reduce demand-side pressure for drug sellers to dispense antibiotics inappropriately.

Colonization of Enteroaggregative Escherichia coli and Shiga toxin-producing Escherichia coli in chickens and humans in southern Vietnam

“…The isolation rate of STEC (0.2 %, 1/458) and EAEC (3.3 %, 15/458) in asymptomatic humans in Vietnam is also similar to the reported prevalence in both developed and developing countries [27–29]. Our results indicate a generally high level of antimicrobial resistance among EAEC isolates from Vietnam compared with results from other countries [30] and overuse of antimicrobials in the community could be one of the possible explanations [31]. …”

Cost-effectiveness of Haemophilus influenzae type b vaccine in Vietnam

“…While both used appropriate case definitions and laboratory techniques, they failed to account for both missing cases and meningitis cases without lumbar puncture, so the reported incidence was likely underestimated. Inappropriate antibiotic use in Vietnam due to common self-medication practices and the ease of antibiotics purchase without prescription is another important issue that probably interferes with true estimates of Hib disease incidences [48]. Although Hib vaccine remained highly cost-effective in sensitivity analyses, the ICERs were especially sensitive to variations in determinants of disease burden, emphasizing the need to have a more precise disease burden estimate.…”

Treatment of pediatric diarrhea: a simulated client study at private pharmacies of Ujjain, Madhya Pradesh, India

“…The dispensing pattern did not vary much in pharmacies with qualified staff. This irrational use of medicines is driven possibly by a lack of knowledge, a pressure to fulfil client expectations, and a need to maximize financial incentives [26]. Education as well as stricter regulations for pharmacies are needed to improve the proper dispensing of medicines.…”

“…Aside from client expectations, private pharmacy staff are also likely to be driven by pecuniary incentives to make decisions on which drugs to dispense. Most clients pay for drugs at pharmacies as an out-of-pocket expense; thus, the pharmacy staff are likely to dispense those drugs that create the best financial incentives [26].…”