Epidemiology of Antibiotic Use and Antimicrobial Resistance in Selected Communities in Thailand.

OBJECTIVE: To generate epidemiological information regarding antibiotic use and antimicrobial resistance (AMR) in targeted communities for use by the Thailand AMR Containment and Prevention Program. MATERIAL AND
METHOD: A survey of antibiotics sold by 215 grocery stores and retail shops located in the target communities was done by the local people who were instructed to purchase specified antibiotics and to present to such stores and shops with symptoms of sore throat, backache, common cold, acute diarrhea, inflamed uterus, and dysuria. The purchased drugs were then identified and recorded. Contamination of extended-spectrum β-lactamase (ESBL)-producing E. coli was identified in 174 samples of foods and open water sources collected from the target communities. Carriage of ESBL-producing E. coli in gastrointestinal tracts of 534 adults living in the target communities was performed by stool sample culture. One thousand three hundred one patients with upper respiratory infection (URI) and 235 patients with acute diarrhea who attended the tambon health promoting hospitals located in the target communities were monitored for their clinical outcomes of treatments. The patients with URI and acute diarrhea with no indication of antibiotic received symptomatic treatments as appropriate and they were followed via telephone contact every few days until all symptoms related to URI and acute diarrhea disappeared. The data were analyzed by descriptive statistics.
RESULTS: Antibiotics were sold to the local people who were presenting with common ailments at many grocery stores and retail shops in their respective communities. In almost all cases, antibiotics were inappropriately given. Overall prevalence of ESBL-producing E. coli contamination in foods and open water sources was 26.4%. ESBL-producing E. coli was isolated from fresh meat and open water sources in many samples. Overall prevalence of ESBL-producing E. coli carriage in gastrointestinal tracts of the adults cultured was 66.5%. All patients with URI and acute diarrhea who had no indication of antibiotics and did not receive antibiotics had either cure or favorable response within seven days of start of symptomatic treatment.
CONCLUSION: Antibiotics are widely available and are inappropriately sold and given by grocery stores and retail shops located within local communities in Thailand. Antibiotic-resistant bacteria commonly and freely circulate within the community. Patients with URI and acute diarrhea with no indication for antibiotic therapy can be treated without antibiotics. Findings and observations from this study will be used as part of a social marketing campaign on prevention and containment of AMR to educate people living within communities in Thailand.