Zawahir Shukry, Le Hien Thi Thu, Nguyen Thu-Anh, Beardsley Justin, Dang Anh Duc, Bernays Sarah, Viney Kerri, Cao Thai Hung, Drabarek Dorothy, Tran Hoang Huy, Nguyen Son Tu, Pham Van Thi Thuy, Luong Tan Minh, Tran Hung Thi Mai, Nguyen Nhung Viet, Jan Stephen, Marais Ben J, Negin Joel, Marks Guy B, Fox Greg J
Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia.
Woolcock Institute of Medical Research, Hanoi, Viet Nam.
Lancet Reg Health West Pac. 2022 Apr 11;23:100447. doi: 10.1016/j.lanwpc.2022.100447. eCollection 2022 Jun.
This study aimed to evaluate the appropriateness of antibiotic dispensing of private pharmacies in Vietnam.
Standardised patient surveys were conducted in randomly selected community pharmacies across 40 districts in Vietnam. Four clinical scenarios were represented by patient actors: (a) an adult requesting treatment for a sibling with a viral upper respiratory tract infection (URTI), (b) a parent requesting treatment for a child with acute diarrhoea, (c) an adult making a direct antibiotic request, and (d) an adult presenting with an antibiotic prescription. We calculated the proportion of interactions that resulted in inappropriate supply of antibiotics and patient advice. Predictors of inappropriate antibiotic supply were assessed.
Patient actors attended 949 pharmacies, resulting in 1266 clinical interactions. Antibiotics were inappropriately supplied to 92% (291/316) of adults requesting treatment for URTI symptoms, 43% (135/316) for children with acute diarrhoea symptoms and to 84% (267/317) of direct request for antibiotics. Only 49% of pharmacies advised patients regarding their antibiotic use. Female actors were more likely to be given antibiotics than male actors for URTI (aOR 2·71, 1·12-6·60) but not for diarrhoeal disease. Pharmacies in northern Vietnam were more likely than those in southern Vietnam to supply antibiotics without a prescription: for adult URTI (aOR=5·8, 95% CI: 2·2-14·9) and childhood diarrhoea (aOR=3·5, 95% CI: 2·0-6·0) symptoms, but less likely to dispense for direct antibiotics request.
Inappropriate antibiotic supply was common in Vietnamese private pharmacies. Multifaceted measures are urgently needed to achieve WHO's global action plan for the optimal use of antimicrobials.
This study was funded by a grant from the Australian Department of Foreign Affairs and Trade.
本研究旨在评估越南私立药店抗生素配药的合理性。
在越南40个地区随机选取的社区药店进行标准化患者调查。患者扮演者呈现了四种临床场景：(a) 一名成年人请求为患病毒性上呼吸道感染（URTI）的兄弟姐妹进行治疗，(b) 一位家长请求为患急性腹泻的孩子进行治疗，(c) 一名成年人直接要求使用抗生素，以及(d) 一名成年人出示抗生素处方。我们计算了导致抗生素供应不当和患者建议不当的互动比例。评估了抗生素供应不当的预测因素。
患者扮演者走访了949家药店，产生了1266次临床互动。对于请求治疗URTI症状的成年人，92%（291/316）的抗生素供应不当；对于有急性腹泻症状的儿童，43%（135/316）供应不当；对于直接要求使用抗生素的情况，84%（267/317）供应不当。只有49%的药店就抗生素使用向患者提供了建议。对于URTI，女性扮演者比男性扮演者更有可能获得抗生素（调整后比值比2·71，1·12 - 6·60），但腹泻疾病并非如此。越南北部的药店比南部的药店更有可能在无处方的情况下供应抗生素：对于成人URTI（调整后比值比=5·8，95%置信区间：2·2 - 14·9）和儿童腹泻（调整后比值比=3·5，95%置信区间：2·0 - 6·0）症状，但对于直接要求使用抗生素的情况供应可能性较小。
越南私立药店抗生素供应不当的情况很常见。迫切需要采取多方面措施来实现世界卫生组织关于抗菌药物最佳使用的全球行动计划。
本研究由澳大利亚外交与贸易部的一项赠款资助。
