ONE-HEALTH APPROACH TO INVESTIGATE AMU AND AMR DRIVERS IN THAILAND

Abstract

Intro: The interim report of the Thai national action plan on antimicrobial resistance (AMR) indicated a 20.9% increase in human antimicrobial use (AMU) (2017-2019). We aimed to investigate sociocultural and economic drivers associated with AMU and AMR in the Thai community. Methods: Mixed methods including microbiological screening of human faecal samples, medicine use survey, record review, and ethnographic case studies including qualitative interviews with community members between 2019-2021. Findings: Of 501 faecal samples from volunteers in the community, 289 (57.7%) were culture positive for 3GC-R E. coli. This was associated with preferentially purchasing food at fresh markets (OR 1.46, 95% CI 1.10 to 1.96) and working with poultry (OR 1.70, 95% CI 1.10 to 2.61). Rates of Fluoroquinolone and Tetracycline resistance among 3GC-R E. coli and Klebsiella spp. isolates were very high. Out of 90 acute disease episodes, 49(54%) of healthcare consultations took place in the private sector, compared to 25(28%) in the public sector and 16(18%) were treated with home/traditional remedies. Only 15(16.6%) reported using antibiotics included Dicloxacillin, Tetracycline, Amoxicillin, and Norfloxacin, but few community members could recognise antibiotics by name or class. The use of repackaged medicine sets (‘Ya Chud’) labelled as treating specific complaints (e.g. cold, flu, fever, pain) were popular among participants. An unknown proportion of antimicrobials consumed in community settings are unrecognised as such by consumers due to the phenomenon of repackaging medicines. This fuelled by competition in the private sector while rational drug use policies mainly target the public sector. Conclusion: Using medicine use surveys to measure AMU may not provide accurate estimates of AMU where medicines details are not shared with patients. There is a need to strengthen prescribing.