Lương Ngọc Khuê, director general of the Medical Examination and Treatment Department under the Ministry of Health, speaks to the Hải Quan (Customs) newspaper about the need to rein in the careless use of antibiotics in Việt Nam.

Would you tell us about the problem of drug resistance in our country?

Antimicrobial resistance (ARM) is the ability of a microbe to resist the effects of medication previously used to treat it. This broader term also covers antibiotic resistance which applies to bacteria and antibiotics. Resistant microbes are increasingly difficult to treat, requiring alternative medication or higher doses, both of which may be more expensive and/or more toxic. Microbes resistant to multiple antimicrobials are called multidrug resistant (MDR). At present, MDR has become a nightmare for humankind.

ARM has become a global health problem, particularly for developing countries. Việt Nam has been listed as one of the countries with the highest percentage of ARM. More seriously, some super bacteria have been detected in our country and they are resistant to all types of antibiotic drugs, particularly the gram negative bacteria found in the intestine.

What are the leading causes of high drug resistance in our country?

The first reason I should mention is the general public’s poor awareness of the use of antibiotic drugs and limited knowledge about antibiotic drugs and their usage. Worse still, people can often buy antibiotic drugs without doctors’ prescriptions. A survey conducted by the Department of Examination and Treatment under the Ministry of Health showed that Amoxicillin, Cephalonia and Azithromycin are the three most commonly antibiotics at pharmacies without prescriptions. The survey also found that up to 88 per cent of antibiotics are sold without prescriptions in urban areas and 91 per cent in rural areas.

From the perspective of the health workers, many doctors have abused antibiotics for their patients, or even prescribed expensive and new generation drugs for them. In addition, the abuse of antibiotics in animal husbandry, poultry rearing and aquaculture is also increasing in Việt Nam.

A recent survey conducted by the MOH found over-prescription of antibiotics by doctors. Up to 50 per cent of hospitalisation costs stem from the cost of drugs, of which 33 percent of antibiotics.

Do you think Việt Nam may face a shortage of antibiotics?

At present, many countries are still using antibiotic drugs of the first generation. But in our country, we have already used antibiotic drugs of the 3^rd and 4^th generations. This is a serious problem for us. As we all know, it takes quite a long time and costs a lot of money to find a new drug generation.

In the period from 1983-1987, the US Food and Drug Administration granted approval to 18 kinds of antibiotic drugs. But since 2008, no new antibiotic drug has been found. This is an indication that the discovery of a new antibiotic drug cannot meet the rapid development of drug-resistant bacteria.

While old antibiotics become resistant, particularly MDR, new ones have not been introduced.

Does the MOH have any measures to prevent drug resistance?

To prevent MDR we have been implementing the WHO Global Strategy for Containment of Antimicrobial Resistance and have already developed our own action plan on the antimicrobial resistance since 2013.

In addition, the MOH has established a National Steering Committee to fight AMR, with the participation of the miniestries of Agriculture and Rural Development, Trade and Industry, and Natural Resources and Environment.

We have also developed guidelines on diagnoses and treatment, particularly the use of antibiotics in hospitals – both public and private ones.

More recently, the health minister decided to create a technical team for surveillance of AMR nationwide from 2017 to 2020. The team’s key task is to co-ordinate with relevant agencies in conducting evaluation missions, writing reports and recommendations to prevent the escalation of AMR. — VNS