By Madlen Davies , Ben Stockton
September 20 2019

Quack pharmacists in Cambodia are fuelling the rise of drug resistant bacteria by incorrectly peddling antibiotics, a study has found.

For the first time researchers have interviewed Cambodia’s “invisible” drug sellers – those who sell from their own homes, visit customers’ houses or wander around markets or villages.

Khan said it “wasn’t difficult” for informal sellers in Cambodia to get antibiotics. Wholesalers would deliver antibiotics to informal sellers or they would be passed on by qualified practitioners. “Drug reps also come directly to the communities on motorbikes to promote or provide medicines,” she said.

The country also has a problem with counterfeit medicines smuggled in from Vietnam, India, Pakistan and China. These include “substandard” antibiotics, anti-malarials and antivirals: those which do not contain enough of the active ingredient, meaning they fuel drug resistance.

The researchers carried out community interviews in seven villages on the outskirts of Phnom Penh and found 62% of people reported using invisible medicine sellers.

full https://www.thebureauinvestigates.com/s ... 0/cambodia

I'm not sure about 'substandard' imports, I guess they mean generics
it sounds like they're trying to protect pharma brands

UPDATED STUDY on antibiotic resistance, including Cambodia

Study reveals alarming pediatric antibiotic prescribing practices in Madagascar, Senegal, and Cambodia
Download PDF Copy
By Neha MathurJun 13, 2023
[excerpts]
In a recent article published in the journal PLOS Medicine, researchers performed a prospective, longitudinal study to estimate the proportion of outpatient consultations resulting in inappropriate antibiotic prescriptions in young children in three low- and middle-income countries (LMICs), Madagascar, Senegal, and Cambodia.
Additionally, they robustly documented disease symptoms and diagnoses in these children while evaluating antibiotic needs during each consultation.

Background
The global burden of bacterial diseases is disproportionately large in children, especially in rural settings of LMICs. Antibiotic overuse and inappropriate antibiotic prescribing drive antibiotic resistance, a global public health concern. Thus, characterizing inappropriate antibiotic prescribing among young outpatient children in LMICs is crucial. At present, relevant data from LMICs, where most inappropriate prescribing occurs, at the community level are scarce. Also, the seasonality of inappropriate antibiotic prescribing in LMICs is poorly documented.
About the study

In the present study, researchers recruited all children from the BIRDY cohort who had at least one outpatient consultation during their follow-up, ranging from six to 24 months from baseline. They received systemic antibiotics administered via intramuscular, oral, or intravenous routes. BIRDY, a prospective, long-term, community-based mother-and-child cohort study, took place in urban and rural regions of Madagascar, Senegal, and Cambodia and estimated the incidence of antibiotic-resistant bacterial infections in children below two years.

First, the researchers calculated the main characteristics of the study population in each country, including the number of consultations, diagnoses, antibiotic prescriptions, and inappropriate antibiotic prescriptions.

Next, they categorized all diagnoses made by the physician at each consultation using a syndromic algorithm based on Integrated Management of Childhood Illness (IMCI) guidelines of the World Health Organization (WHO) to determine all infectious diagnoses. Likewise, they used a two-step standardized classification algorithm to determine which health events required antibiotics.

During children consultations, doctors inappropriately prescribed antibiotics to many children, even for health events that did not require antibiotic therapy. Moreover, some children received multiple diagnoses\multiple antibiotic prescriptions during a consultation.

Thus, in this study, the researchers considered the number of children consultations not requiring antibiotics and the number of antibiotics prescribed during consultations but not requiring antibiotics as distinct outcomes.

Results
Nearly a quarter of outpatient consultations did not require antibiotic therapy; nonetheless, they resulted in an antibiotic prescription. Similarly, three-quarters of all children consultations ending up in antibiotic prescriptions were inappropriate, and approximately two-thirds of those prescribed for young children were unnecessary. While these inappropriate antibiotic prescriptions provided little to no benefit, they inadvertently harmed these young children by contributing to the emergence of antibiotic resistance.

Further, the study results suggested that inappropriate antibiotic prescribing is frequent but highly heterogeneous across countries. Accordingly, while only 16% of consultations not requiring antibiotics resulted in antibiotic prescriptions in Senegal, the figures for Cambodia were much higher, i.e., ~57%.

In this study, researchers documented all disease episodes microbiologically. They noted that 36% of children received antibiotics even when their diagnostic tests detected no pathogens in the stool. In fact, doctors prescribed antibiotics inappropriately for children with gastroenteritis in 24.6%, 51.2%, and 61.6% of cases in Madagascar, Senegal, and Cambodia, respectively.

Full article: https://www.news-medical.net/news/20230 ... bodia.aspx

Kammekor wrote: ↑Tue Jun 13, 2023 8:42 pm

Kung-fu Hillbilly wrote: ↑Fri Sep 20, 2019 11:03 pm
For the first time researchers have interviewed Cambodia’s “invisible” drug sellers – those who sell from their own homes, visit customers’ houses or wander around markets or villages.

I call b&llsh!t on this study.
Why buy from 'invisible' sellers when the same drug can be bought at any pharmacy without a subscription?

Not denying the abuse of antibiotics in Cambodia by the way. The way this country organizes its' healthcare is fueling resistance.

Well actually antibiotics does by law require a prescription in Cambodia since a few years.

But still, as with most, who cares about the law here?

Edit: I remember a neighbor Khmer lady in sihanoukville many years back who would take a single pill of antibiotics she had every day to "stay healthy". This is the reason they made it so that you should have to talk to a doctor first. In theory at least.