1. Background: Tomson G 1, Kronvall G 2, Chuc NTK 3, Binh NT 4, Chalker J 5, Falkenberg T 1. 1 Div. International Health (IHCAR), Dep. Public Health Sciencies, and 2 Microbiology & Tumor Biology Center, Karolinska Institute, Sweden; 3 Hanoi Medical University, 4 College of Pharmacy, Vietnam; 5 Management Sciences for Health, USA. In high-income countries, self-medication with antibiotics is prevented by easy access to affordable health care and strict regulations regarding prescription-only drugs. However, in low-income countries enforcement of prescription regulation may exclude the poorest from accessibility of drugs, leading to increased vulnerability to infectious diseases. However, if drugs can be purchased without restrictions, the affordable antibiotics may soon be useless. To improve antibiotic use without decreasing availability empowerment of drug providers, e.g. private pharmacy staff, to make simple diagnostic evaluations and detect danger signs and when relevant refer to physician in accordance with Good Pharmacy Practice (GPP) may be a useful strategy. 1 In low-income countries, infectious diseases still account for 45% of the mortality. Availability and affordability of drugs is crucial in order to achieve improved health among the poorest. In Vietnam there were shortages of drugs until the late 1980’s. In 1986 an economic reform towards market economy”Doi Moi” was initiated. Private health care expanded rapidly and by 1994 per capita drug consumption had increased six-fold. Antibiotic use suppresses the susceptible flora and selects for antibiotic resistant bacterial stains. Increased bacterial resistance leads to treatment failures, longer and more severe illness episodes, higher costs and increased mortality rates. - The majority of children in the community were reported to have self- medicated with antibiotics during the past month, and high rates of antibiotic resistance in respiratory pathogens were found. - The main source of self-medicated antibiotics were private pharmacies and a majority of the children surveyed at the Bavi hospital had used antibiotics prior to the consultation. - The average number of drugs per prescription was high, and injections were common. Few of the children, who were prescribed antibiotics, had elevated CRP levels. - Management of ARI and STD as well as of prescription- only drugs in private pharmacies were shown to be of low quality. - There were discrepancies between knowledge and practice among private pharmacies. - It was possible to improve private pharmacy practice in line with GPP through a multi-component intervention. - Investigations addressing the effects of self-medication with antibiotics on community morbidity and mortality as well as consequences for resistance are recommended. - The relationship between use and resistance, and whether improvements in antibiotic utilization can be linked to changes in resistance patterns needs to be increasingly investigated, in order to safeguard the therapeutic effect of antibiotics. - These findings underline the need for interventions aiming to improve public sector prescribing practice, as well as private pharmacy provision practice in Vietnam. - Further studies on how interventions can be developed in order to facilitate private pharmacy participation as an integrated part of the health care system are suggested. - Standard treatment guidelines and pharmacy treatment guidelines need to be developed in relation to updated information regarding the current resistance situation. - Assessment methods including knowledge as well as practice are recommended for evaluation of interventions and monitoring of GPP. Conclusion Recommendations Contact Mattias Larsson MD, PhD Div. International Health (IHCAR), Dep. Public Health Sciencies, Karolinska Institutet SE 171 76 Stockholm Sweden e-mail: mattias.larsson@phs.ki.se tel: +46(0)707663068 Fax: +46(0)8311590 Thesis on the web: http://diss.kib.ki.se/2003/91-7349-630-8/ Main Objective: To assess drug utilization in public and private sector, antibiotic use and resistance in the community as well as the effect of an intervention package to improve case management in private pharmacies. 30 Intervention & 30 control pharmacies Significantly less prescription only drugs dispensed on request without prescription; Significantly less antibiotics dispensed without indication; Significantly improved Case management of ARI and STD.