The unseen use of antimicrobials: Drivers of human antibiotic use in a community in Thailand and implications for surveillance
The unseen use of antimicrobials: Drivers of human antibiotic use in a community in Thailand and implications for surveillance
复制标题
DOI：
10.1080/17441692.2023.2298940
复制
发表时间：
2024-12-31
影响因子：
3.3
通讯作者：
Lambert，Helen
中科院分区：
文献类型：
--
作者：
Alhusein，Nour;Charoenboon，Nutcha;Lambert，Helen
我们通过民族志研究、访谈、焦点小组和横断面调查，调查了泰国人类抗菌药物使用（AMU）的社会文化和经济驱动因素。这项以社区为基础的研究产生了围绕三个关键主题的研究结果：寻求治疗的做法，药物使用和生物医学结构的解释。参与者寻求公共卫生机构对慢性病的治疗，但私营部门的药物被认为更有效，更适合急性疾病。由于私人医疗机构在分发重新包装的药物时没有识别标签，许多抗生素没有被消费者识别。这种看不见的抗生素使用可能是由经济驱动因素驱动的，包括私营部门的市场竞争、政策执行驱动因素（其中合理用药政策主要针对公共部门）、与寻求治疗做法有关的行为驱动因素以及影响参与者对医学术语和概念的理解的社会文化驱动因素。参与者认为抗生素可以减少炎症，并且不确定抗炎药，抗生素和止痛药之间的区别。抗生素耐药性（AMR）被认为是一种通过改变药物来补救的药物耐受性。社区调查可能无法提供AMU的准确估计，因为人们无法可靠地区分抗生素和其他药物。
We investigated sociocultural and economic drivers of human antimicrobial use (AMU) in Thailand through ethnographic research, interviews, focus groups and a cross-sectional survey. This community-based study generated findings clustered around three key themes: treatment-seeking practices, medicine use, and interpretation of biomedical constructs. Participants sought care from public health facilities for chronic conditions, but medicines from the private sector were considered more powerful and were preferred for acute complaints. Many antibiotics were unrecognised as such by consumers due to the practice at private healthcare facilities of dispensing repackaged medicines without identifying labels. This unseen use of antibiotics is probably driven by economic drivers including market competition in the private sector, policy implementation drivers whereby rational drug use policies mainly target the public sector, behavioural drivers relating to treatment seeking-practices, and sociocultural drivers that influenced participants’ understanding of medical terms and concepts. Participants regarded antibiotics as reducing inflammation and were uncertain about the distinctions between anti-inflammatories, antibiotics, and pain relievers. Antimicrobial Resistance (AMR) was understood as a form of drug tolerance to be remedied by changing the medicine. Community surveys may not provide accurate estimates of AMU where people are unable to distinguish antibiotics reliably from other medicines.