title: Antibiotic use and resistance in emerging economies: a situation analysis for Viet Nam.
abstract: BACKGROUND
  Antimicrobial resistance is a major contemporary public health threat. Strategies to contain antimicrobial resistance have been comprehensively set forth, however in developing countries where the need for effective antimicrobials is greatest implementation has proved problematic. A better understanding of patterns and determinants of antibiotic use and resistance in emerging economies may permit more appropriately targeted interventions.Viet Nam, with a large population, high burden of infectious disease and relatively unrestricted access to medication, is an excellent case study of the difficulties faced by emerging economies in controlling antimicrobial resistance.
  
  
  METHODS
  Our working group conducted a situation analysis of the current patterns and determinants of antibiotic use and resistance in Viet Nam. International publications and local reports published between 1-1-1990 and 31-8-2012 were reviewed. All stakeholders analyzed the findings at a policy workshop and feasible recommendations were suggested to improve antibiotic use in Viet Nam.Here we report the results of our situation analysis focusing on: the healthcare system, drug regulation and supply; antibiotic resistance and infection control; and agricultural antibiotic use.
  
  
  RESULTS
  Market reforms have improved healthcare access in Viet Nam and contributed to better health outcomes. However, increased accessibility has been accompanied by injudicious antibiotic use in hospitals and the community, with predictable escalation in bacterial resistance. Prescribing practices are poor and self-medication is common - often being the most affordable way to access healthcare. Many policies exist to regulate antibiotic use but enforcement is insufficient or lacking.Pneumococcal penicillin-resistance rates are the highest in Asia and carbapenem-resistant bacteria (notably NDM-1) have recently emerged. Hospital acquired infections, predominantly with multi-drug resistant Gram-negative organisms, place additional strain on limited resources. Widespread agricultural antibiotic use further propagates antimicrobial resistance.
  
  
  CONCLUSIONS
  Future legislation regarding antibiotic access must alter incentives for purchasers and providers and ensure effective enforcement. The Ministry of Health recently initiated a national action plan and approved a multicenter health improvement project to strengthen national capacity for antimicrobial stewardship in Viet Nam. This analysis provided important input to these initiatives. Our methodologies and findings may be of use to others across the world tackling the growing threat of antibiotic resistance.
authors: Kinh Van
authors: KV
authors: Nguyen
authors: Nga Thuy
authors: NT
authors: Thi Do
authors: Arjun
authors: A
authors: Chandna
authors: Trung Vu
authors: TV
authors: Nguyen
authors: Ca Van
authors: CV
authors: Pham
authors: Phuong Mai
authors: PM
authors: Doan
authors: An Quoc
authors: AQ
authors: Nguyen
authors: Chuc Kim
authors: CK
authors: Thi Nguyen
authors: Mattias
authors: M
authors: Larsson
authors: Socorro
authors: S
authors: Escalante
authors: Babatunde
authors: B
authors: Olowokure
authors: Ramanan
authors: R
authors: Laxminarayan
authors: Hellen
authors: H
authors: Gelband
authors: Peter
authors: P
authors: Horby
authors: Ha Bich
authors: HB
authors: Thi Ngo
authors: Mai Thanh
authors: MT
authors: Hoang
authors: Jeremy
authors: J
authors: Farrar
authors: Tran Tinh
authors: TT
authors: Hien
authors: Oxford University Clinical Research Unit, Hanoi, Viet Nam. heiman.wertheim@gmail.com.
authors: Heiman F L
authors: HF
authors: Wertheim
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy*; D003906:Developing Countries; D024881:Drug Resistance, Bacterial; D004363:Drug Utilization / Q000592:standards; D006291:Health Policy; D006801:Humans; D014744:Vietnam
chemical_list: D000900:Anti-Bacterial Agents