Antibiotic medication and bacterial resistance to antibiotics: a survey ofchildren in a Vietnamese community

OBJECTIVE To investigate antibiotic use and antibiotic susceptibility of re spiratory tract pathogens in children aged 1-5 years in Bavi, Vietnam. METHOD Nasopharynx and throat specimens were collected from 200 children fr om randomly selected households in a demographically defined population. Re spiratory isolates were tested for antibiotic susceptibility according to t he standard disk diffusion method. A questionnaire survey of carers elicite d information on type of antibiotic used, duration of treatment, where the antibiotics had been purchased, type of treatment information retained by c arers and episodes of illness preceding the study. RESULTS 82% of the children had at least one symptom of acute respiratory t ract infection (ARI) in the 4 weeks prior to the study, and of these 91% we re treated with antibiotics. The most commonly used antibiotics were ampici llin (74%), penicillin (12%), amoxicillin (11%), erythromycin (5%), tetracy cline (4%) and streptomycin (2%). Ampicillin was used for 3.3 days on avera ge (SD:1.8) and penicillin for 2.6 days (SD:0.7). When deciding which antib iotic to use, 67% of the carers consulted the pharmacy seller, 11% decided themselves and 22% followed the doctor's prescription. The carrier rate of Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis was 50%, 39% and 17%, respectively. Isolates from 145 children were suscept ibility tested, and 74% were found to carry resistant pathogens. Of the tes ted isolates, 90% of S. pneumoniae, 68% of H. influenzae and 74% of M. cata rrhalis were resistant to at least one antibiotic. The mean number of antib iotics (susceptible strains excluded) to which resistance was found was 2.0 (SD:1.2), 2.5 (SD:1.8) and 2.1 (SD:0.9), respectively. S. pneumoniae and H . influenzae showed high resistance to tetracycline (88% and 32%, respectiv ely), trimethoprim/sulphonamide (32% and 44%), and chloramphenicol (25% and 24%). 23% of S. pneumoniae were erythromycin-resistant and 18% of H. influ enzae isolates were resistant to ampicillin. There was a significant differ ence in ampicillin and penicillin resistance between the group of children previously treated with beta lactam antibiotics and the group of children w ho did not receive antibiotics. CONCLUSION As reported by the carers, children in Bavi are treated with ant ibiotics frequently. Most antibiotics were obtained without consulting a do ctor. High levels of antibiotic resistance and high prevalence of multidrug -resistant strains were found among respiratory pathogens. The existence of a large reservoir of resistance genes among children in low-income countri es represents a threat to the success of antibiotic therapy throughout the world. Multi-faceted programmes to improve rational use of antibiotics in V ietnam are urgently needed.