Trends in antimicrobial consumption in Bhutan.

Introduction: Antimicrobial use has been recognized as one of the main drivers of antimicrobial resistanceand it is, therefore, crucial to monitor the consumption and use of antimicrobials. This study was conducted to determine the consumption of antimicrobials in terms of defined daily doses (DDDs) per 1000 inhabitants per day (DIDs) at both national and dzongkhag levels in Bhutan, and to investigate trends from 2017 to 2019. Methods: A retrospective analysis of antimicrobial consumption in healthcare facilities in Bhutan from 2017 to 2019 was undertaken using the national records of annual distribution of medicines. World Health Organization Anatomical Therapeutic Chemical (ATC) Classification System/DDD methodology was used for data collection and analysis. Results: In 2019, the consumption of antimicrobials (ATC subgroup J01) for systemic use in healthcare facilities in Bhutan was 16.29 DIDs, compared with 14.39 DIDs in 2018 and 13.27 DIDs in 2017. The most commonly used subgroup of antimicrobials was the penicillin group of beta-lactams (J01C). Conclusion: Antimicrobial consumption in Bhutan was found to be lower than the European Union and European Economic Area average, and lower compared with most Eastern European countries and some countries in the Western Pacific region. However, overall consumption in Bhutan increased steadily over the 3-year study period. This should be monitored carefully, and appropriate interventions to optimize antimicrobial use should be put in place in the near future.

Antibiotic resistance in Neisseria gonorrhoea and treatment outcomes of gonococcal urethritis suspected patients in two large hospitals in Bhutan, 2015.

INTRODUCTION: Gonorrhea is a major sexually transmitted infection (STI) globally with increasing trends. Despite limited data, gonorrhea remains an important public health problem in Bhutan. METHODS: A descriptive study was carried out in two Bhutanese hospitals; Jigme Dorji Wangchuck National Referral Hospital and Phuentsholing General Hospital in 2015. Patients suspected of gonococcal urethritis were sampled, treated and followed up at two weeks. Gonococcal isolates were identified and tested for antibiotic susceptibility by the Calibrated Dichotomous Sensitivity Test (CDS) method. RESULTS: Of the 524 patients, 2.3% (12) were females. Most (46.6%) patients belonged to the 26-35 years age group. About 58% were lost to follow up; 62% (277) of males and all (12) females. N. gonorrhoea was positive in 76% (398) of microscopy and 73.1% (383) by culture. Resistance against ciprofloxacin, penicillin, tetracycline and nalidixic acid were 85.1%, 99.2%, 84.8% and 99.7% respectively. Nearly all the isolates were sensitive to cefpodoxime, ceftriaxone and azithromycin. Sixty-seven percent (350) were treated with injection ceftriaxone alone, 32% (169) with ceftriaxone and oral doxycycline and 1% (5) with ceftriaxone, doxycycline and metronidazole. Probable treatment failure was seen only in one patient (0.5%). CONCLUSIONS: Gonococcal resistance to currently used antibiotics was low and there was a high clinical cure rate. Compliance to treatment guidelines need reinforcement addressing antibiotic regimen, tracing sexual partners and addressing the social stigma. National STI programs should be more women-friendly for effective management, prevention and control of STIs. Laboratories must adopt more reliable susceptibility testing methods, the Minimum Inhibition Concentration method.

Assessing the Knowledge, Attitudes, and Practices on Antibiotics Among the General Public Attending the Outpatient Pharmacy Units of Hospitals in Bhutan: A Cross-Sectional Survey.

We assessed the level of knowledge, attitudes, and practices on antibiotics through a questionnaire-based cross-sectional survey among the general public in Bhutan. Of the 692 participants, 52.6% (364) were females with a mean age of 34.2 years. More than half of the respondents showed unsatisfactory knowledge varying significantly from 23.1% to 69.6%. Cotrimoxazole (septran) was the least known while amoxicillin was the most known antibiotics assessed. Two-thirds of the responsents (267) knew that inappropriate use of antibiotics could lead to antimicrobial resistance and 89% (319) were aware of the need to complete the antibiotic courses. In bivariate analysis, satisfactory knowledge was associated with the education level of graduate and higher as compared with no education. This study revealed unsatisfactory knowledge and attitude but satisfactory practices on antibiotics use among participants. Efforts are needed to improve public awareness on antibiotics. Enforcement of regulations on sale of antibiotics over the counter needs a revamp.