Outpatient antibiotic use in acute respiratory infections in Ho Chi Minh City, Vietnam

Ngo, Ngoc Quang Minh (2014). Outpatient antibiotic use in acute respiratory infections in Ho Chi Minh City, Vietnam. PhD thesis The Open University.

DOI: https://doi.org/10.21954/ou.ro.0000ef1a


Acute respiratory infections (ART) are among the most frequent infectious diseases in children worldwide, particularly in developing countries. Antibiotics are very often prescribed or purchased without prescription for the treatment of ARl, although viruses are recognised as the predominant pathogens [1-7].

The aim of the work presented in this thesis was to quantify antibiotic use in outpatients with ARI in Children's Hospital 1, Ho Chi Minh City, Vietnam, to identify the viral and bacterial respiratory aetiologic agents and to assess the impact of antibiotic use on the selection of resistant bacteria in the intestinal flora.

Two prospective descriptive studies were conducted in the outpatient clinic: one in ARl patients and the other in healthy children. The epidemiology, presentation and treatment characteristics of children with ARI in the outpatient clinic were described. Antibiotics were prescribed in 99.6% of 563 patients while respiratory viruses were detected in 72.5% among these patients with the use of multiplex PCR in respiratory specimens. Antibiotic use was considered inappropriate in 67.7% of cases, according to evidence-based guidelines and detected pathogens. Besides antibiotics, other treatments such as oral bronchodilators, oral corticosteroids, antihistamines, and mucolytic agents were commonly used at the rates of 57.6%, 10.3%, 11 % and 11 %, respectively, and in most of the cases, were not in accordance with the current guidelines. We observed a short-term selection of resistant Enterobacteriaceae in patients' intestinal flora resistant not only to the antibiotic class the patients received but also co-selection of resistance to other rarely used antibiotics. HPLC assays were developed with high sensitivity and specificity to determine the presence of 6 beta- lactam antibiotics in the urine antibiotic use before presentation as determined by HPLC (32%) was significantly higher than that reported by parent interviews (21 %). Antibiotic use in Vietnam is largely unrestricted leading to overuse and overprescription for uncomplicated ARI.

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