Antimicrobial resistance (AMR) is increasingly recognised as a global health threat. However the scientific and political consensus is still emerging on how best to translate antimicrobial stewardship approaches into policy and practice in low- and middle-income countries, where ensuring access to appropriate antibiotics may remain a challenge and a potentially conflicting policy priority.
In Vietnam, iDSI has been collaborating as part of a Working Group convened by Medical Services Administration, Ministry of Health and the Oxford University Clinical Research Unit (OUCRU) to develop quality standards for better antibiotic prescribing practices, as a key element of better patient care in specific high-priority clinical conditions. In 2016, we developed draft quality standards on improving antibiotic prescribing in acute exacerbations of chronic obstructive pulmonary disease (COPD) and community-acquired pneumonia. COPD and lower respiratory tract infections together account for 8% of deaths in Vietnam, greater than for heart disease, and there is evidence of significant inappropriate antibiotic prescribing.
The draft quality standards were presented to a national Quality Standards & Indicators Committee at a workshop in Hanoi, June 2016. The Committee comprised senior officials from the Ministry of Health, as well as over 40 frontline clinicians from various disciplines among central and provincial hospitals across Vietnam. The workshop generated robust discussion among Committee members, particularly around the the feasibility of international best practice in diagnostic tests in the Vietnamese public hospital setting, and the choice of first-line treatment where a substantial proportion of patients may have used antibiotics recently, and there is little scientific evidence about local microbial strains and antibiotic resistance patterns.
These discussions will serve as valuable inputs for the Working Group who will finalise the quality standards and submit them for the Committee’s approval in Q4 2016.