Pharmacists in Cambodia have a particular affinity for prescribing antibiotics, so much so that resistance to the drugs has become a public health problem worthy of a national response.
Antimicrobial resistance (AMR)—when micro-organisms in humans develop resistance to drugs such as antibiotics, antivirals and antimalarials—makes standard treatment for both simple and high-risk diseases ineffective.
For people who have developed AMR, minor infections can be deadly, according to Alex Costa, technical officer at the World Health Organization (WHO) in Cambodia.
“Simple procedures like dental surgery can become lethal,” Dr. Costa said.
Although Cambodia was the first country in the world to impose an official ban on artemisinin-based monotherapy to prevent resistance to anti-malaria drugs, regulations around those used to treat more common illnesses are largely ignored, he said.
“Cambodia has taken actions to fight resistance to tuberculosis and malaria [medications], but antibiotic resistance is out of the radar and that is a big problem,” Dr. Costa said.
“There [are] regulations for the sale of antibiotics but they are not enforced; anyone can buy over the counter,” he said, pointing out that “antibiotics are very cheap and a big source of income for pharmacists.”
But the government is preparing to take action to address the problem, according to Ly Sovann, head of the Health Ministry’s communicable disease department.
Over the past 12 months, together with the WHO and other organizations, the ministry has developed a National Policy to Combat Antimicrobial Resistance in Cambodia and an associated three-year plan for implementation.
“We know this is a problem, a regional one and in the world. That is why we want a new policy to attack [AMR] in Cambodia,” Dr. Sovann said.
“The [launch] will be soon, it will be soon. We are in the final stages to finalize it, then it will obtain the approval of the higher level,” he said, declining to provide details until his superiors had signed off on the plan.
Eng Lengsea, head of the microbiology laboratory at Phnom Penh’s Calmette Hospital, has been monitoring AMR among patients over the past five years. Her research—which provides some of the only data available on the issue in the country—has found that resistance to popular antibiotics is increasing quickly.
“From 2010 to 2014, resistance of Amoxicillin, which is very popular for treating infections, has increased from 50 to 70 percent,” Dr. Lengsea said.
Doctors at private hospitals feel pressured to “satisfy” their patients, Dr. Lengsea explained, and therefore prescribe high-dosage antibiotics.
“They don’t want to risk failure of treatment,” she said. “They don’t want to choose low level of antibiotics, they want a high chance of success.”
Dr. Lengsea said pharmaceutical companies also “motivate doctors” to prescribe newer antibiotics—which are typically more expensive than their well-established competitors.
“This can participate in increasing resistance because if you skip from Amoxicillin to another antibiotic, then you become resistant to both,” Dr. Lengsea said.
The WHO’s Dr. Costa, who has been working with the government on the new AMR policy, said the growing resistance must be tackled through awareness-raising and changing people’s behavior.
“In villages, mobile vendors on their motos offer bags filled with colored pills—cocktails of six, eight or nine different types of drugs. They sell them to traditional healers, nurses and people on the street, but people have no idea what they are taking,” he said.
“The very first step to tackle AMR is to raise awareness and promote change in behavior so people will use antibiotics rationally.”