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Antibiotic sales in rural and urban pharmacies in northern Vietnam: an observational study
Open accessAbstract
BACKGROUND: The irrational overuse of antibiotics should be minimized as it drives the development of antibiotic resistance, but changing these practices is challenging. A better understanding is needed of practices and economic incentives for antibiotic dispensing in order to design effective interventions to reduce inappropriate antibiotic use. Here we report on both quantitative and qualitative aspects of antibiotic sales in private pharmacies in northern Vietnam. METHOD: A cross-sectional study was conducted in which all drug sales were observed and recorded for three consecutive days at thirty private pharmacies, 15 urban and 15 rural, in the Hanoi region in 2010. The proportion of antibiotics to total drug sales was assessed and the revenue was calculated for rural and urban settings. Pharmacists and drug sellers were interviewed by a semi-structured questionnaire and in-depth interviews to understand the incentive structure of antibiotic dispensing. RESULTS: In total 2953 drug sale transactions (2083 urban and 870 rural) were observed. Antibiotics contributed 24% and 18% to the total revenue of pharmacies in urban and rural, respectively. Most antibiotics were sold without a prescription: 88% in urban and 91% in rural pharmacies. The most frequent reported reason for buying antibiotics was cough in the urban setting (32%) and fever in the rural area (22%). Consumers commonly requested antibiotics without having a prescription: 50% in urban and 28% in rural area. The qualitative data revealed that drug sellers and customer's knowledge of antibiotics and antibiotic resistance were low, particularly in rural area. CONCLUSION: Over the counter sales of antibiotic without a prescription remains a major problem in Vietnam. Suggested areas of improvement are enforcement of regulations and pricing policies and educational programs to increase the knowledge of drug sellers as well as to increase community awareness to reduce demand-side pressure for drug sellers to dispense antibiotics inappropriately.
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“This observation parallels findings by Nga et al in Vietnam, which noted that pharmacies in residential areas were more likely to dispense antibiotics without a prescription than those in rural settings. 19”
From Evaluation of antibiotic dispensing without prescription by community pharmacies: a simulated patient study (2025) · cites this paper as [19]
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“Such inconsistency in dispensing practice will, in the long run, cost those CDROs that are adhering to the ethical and regulatory standards by losing trust of customers and eventually hurting their business [24, 40, 42, 46–49].”
From No prescription? No problem: drivers of non-prescribed sale of antibiotics among community drug retail outlets in low and middle income countries: a systematic review of qualitative studies (2021) · cites this paper as [48]
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“In such environments where customer satisfaction or need is of a central value, most CDRO staff opt to respond to customer’s request and need without properly scrutinising the consequences or repercussion of their actions [24, 39, 40, 42–44, 46–48].”
From No prescription? No problem: drivers of non-prescribed sale of antibiotics among community drug retail outlets in low and middle income countries: a systematic review of qualitative studies (2021) · cites this paper as [48]
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“if they experience poor satisfaction with the services of health facilities in nearby areas (e.g. prolonged waiting time due to the overcrowded services, doctors unable/unwilling to have enough consultation time with patients and less quality service) [40–42, 47–49]”
From No prescription? No problem: drivers of non-prescribed sale of antibiotics among community drug retail outlets in low and middle income countries: a systematic review of qualitative studies (2021) · cites this paper as [48]
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“Nearly all (n = 10) [24, 39–43, 45, 46, 48, 49] met seven or more of the 10 JBI appraisal checklist criteria for qualitative studies.”
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“if they feel like their condition is not severe enough to visit a doctor [48]”
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“In addition, CDRO staff reported lack of knowledge regarding the regulatory frameworks governing antibiotic dispensing and/or being misinformed about these policies (e.g. assuming some types of antibiotics are permitted to be sold as OTC medicines) [48].”
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“This tells us that drivers may not be similar between urban and rural CDROs [48, 75].”
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Citations
Cites
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Cited by
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Items 101–200 of 228
Analisis Perilaku dan Faktor Penyebab Perilaku Penggunaan Antibiotik Tanpa Resep di Surabaya
Djawaria, D. P. A., Setiadi, A. P., & Setiawan, E. (2018) · Media Kesehatan Masyarakat Indonesia · doi:10.30597/mkmi.v14i4.5080 · Cited by 35
“antibiotik lini pertama untuk mengatasi berbagai infeksi di rumah sakit.(9-11,18,19) Peningkatan penggunaan antibiotik lini pertama tersebut terbukti”
BackgroundHayat, K., Li, P., Rosenthal, M., Xu, S., Chang, J., Gillani, A. H., Khan, F. U., Sarwar, M. R., Ji, S., Shi, L., et al. (2019) · Expert Review of Anti-infective Therapy · doi:10.1080/14787210.2019.1692655 · Cited by 21
Knowledge, attitude, perception and practice of antibiotics usage among the pharmacy students
Kandasamy, G., Sivanandy, P., Almaghaslah, D., Khobrani, M. A., Chinnadhurai, M., Vasudevan, R., & Almeleebia, T. M. (2020) · International Journal of Clinical Practice · doi:10.1111/ijcp.13599 · Cited by 21
Rousham, E. K., Nahar, P., Uddin, M. R., Islam, M. A., Nizame, F. A., Khisa, N., Akter, S. M. S., Munim, M. S., Rahman, M. M., & UNICOMB, L. E. (2023) · BMC Public Health · doi:10.1186/s12889-023-15155-3 · Cited by 20
“In Vietnam, 88% (urban) and 91% (rural) of sales in a survey of 17 pharmacies were without prescription [7].”
BackgroundResultInfluentialPham, G. N., Dang, T. T. H., Nguyen, T. A., Zawahir, S., Le, H. T. T., Negin, J., Schneider, C. H., & Fox, G. J. (2024) · Antimicrobial Resistance and Infection Control · doi:10.1186/s13756-024-01364-x · Cited by 20
Antibiotic disposal challenges in India: investigating causes and effects
Singh, S., Sharma, P., Pal, N., Sarma, D. K., & Kumar, M. (2024) · Environmental Monitoring and Assessment · doi:10.1007/s10661-024-12425-4 · Cited by 20
“Numerous studies underscore that a significant portion of antibiotic usage transpires within the community setting, where antibiotics are readily accessible and can be procured without a prescription (Nga et al., 2014, Cortez et al., 2017).”
Saleem, Z., Faller, E. M., Godman, B., Malik, M. S. A., Iftikhar, A., Iqbal, S., Akbar, A., Hashim, M., Amin, A., Javeed, S., et al. (2021) · Medicine Access Point of Care · doi:10.1177/23992026211064714 · Cited by 19
“One of the reasons for the increasing spread of AMR in this region is the high rate of irrational use of antibiotics (37-40).”
BackgroundAl-Rukban, M. O., AlRuthia, Y. S., Almasaoud, M. A., Alowairdhi, M. A., Alsouan, A. A., Alrabiah, A., Al-Shaikh, A. H., Alsuhaibani, A. A., & Aleidan, A. (2020) · Risk Management and Healthcare Policy · doi:10.2147/rmhp.s278404 · Cited by 19
Overview of Pharmacovigilance System in Vietnam: Lessons Learned in a Resource-Restricted Country
Nguyen, K. D., Nguyen, P.-T., Nguyen, H. A., Roussin, A., Montastruc, J., Bagheri, H., & Olsson, S. (2017) · Drug Safety · doi:10.1007/s40264-017-0598-y · Cited by 19
“advice of pharmacy staff who may have had only 2 or 3 years of pharmacy education or may even be untrained [31].”
BackgroundDillard, L. K., Wu, C. Z., Saunders, J. E., & McMahon, C. M. (2021) · Research in Social and Administrative Pharmacy · doi:10.1016/j.sapharm.2021.10.004 · Cited by 18
Di, K. N., Tay, S. T., Ponnampalavanar, S. S. L., Phạm, D. T., & Wong, L. P. (2022) · Antibiotics · doi:10.3390/antibiotics11040471 · Cited by 18
“Vietnam has been facing a high level of ABR as antimicrobials account for over 50% of the total utilized drugs, and are the most popularly dispensed drugs in community pharmacies [16].”
BackgroundUlaya, G., Nguyen, T., Vu, B. N. T., Dang, D. A., Nguyen, H. A. T., Tran, H. H., Kieu, H. T. T., Reeve, M., Pham, Q. D., Trinh, T. S., et al. (2022) · Antibiotics · doi:10.3390/antibiotics11121751 · Cited by 18
“Non-prescription antibiotic use is high in Vietnam, with 90% of antibiotic sales in pharmacies being made without a prescription; this is driven strongly by consumer demand [10].”
BackgroundCommunity Pharmacists' Knowledge, Attitude, and Nonprescription Dispensing Practices of Antibiotics
Kumar, K. S., Saranya, S., & Rani, N. V. (2022) · Journal of Research in Pharmacy Practice · doi:10.4103/jrpp.jrpp_48_21 · Cited by 21
“Most studies have reported that more than 50% of antibiotics worldwide are sold without a prescription, especially in developing countries where access to antibiotics is not well regulated.[20,21]”
BackgroundLambraki, I. A., Chadag, M. V., Cousins, M., Graells, T., Léger, A., Henriksson, P. J. G., Troell, M. F., Harbarth, S., Wernli, D., Jørgensen, P. S., et al. (2023) · Frontiers in Microbiology · doi:10.3389/fmicb.2022.992507 · Cited by 18
“Other participants identified social factors influencing AMR in SEA which are also found in the literature, and included: lack of awareness about AMR, antimicrobials and their proper use among the public, food service industry, prescribers, drug sellers, farmers, and knowledge brokers, such as government officers; ina…”
BackgroundBeardsley, J., Chambers, J. M., Lam, T. T., Zawahir, S., Le, H., Nguyen, T. A., Walsh, M., Van, P. T. T., Van, N. T. C., Hoang, T. H., et al. (2022) · The Lancet Regional Health - Western Pacific · doi:10.1016/j.lanwpc.2022.100668 · Cited by 17
Practices and motives behind antibiotics provision in drug outlets in Tanzania: A qualitative study
Ndaki, P. M., Mwanga, J. R., Mushi, M. F., Konje, E. T., Fredricks, K. J., Kesby, M., Sandeman, A., Mugassa, S., Manyiri, M. W., Loza, O., et al. (2023) · PLoS ONE · doi:10.1371/journal.pone.0290638 · Cited by 17
Minh, N. N. Q., Toi, P. V., Qui, L. M., Tinh, L. B. B., Ngoc, N. T., Kim, L. T. N., Uyen, N. H., Hang, V. T. T., B’Krong, N. T. T. C., Thắm, N. T., et al. (2020) · PLoS ONE · doi:10.1371/journal.pone.0241760 · Cited by 17
“000 pharmacies in Vietnam (of which 90% without prescription) and these are dependent on antibiotic sales for 25% of their revenue [12].”
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Self-citationThai, S. N., Vu, H. T. T., Vu, L. T. K., Do, N. T. Q., Tran, A. T. H., Tang, N. T., Le, H. N. M., & Bình, T. Q. (2019) · Journal of Microbiology and Biotechnology · doi:10.4014/jmb.1904.04052 · Cited by 16
“(iii) The prevalence of inappropriate indications for antibiotic prescriptions is high in hospitals in Vietnam [33], and most antibiotics are sold without a prescription in pharmacies: 88% and 91% in urban and rural areas, respectively [34].”
BackgroundPereira-Dias, J., Minh, C. N. N., Hong, C. T. T., Nguyen, T. N. T., Thanh, T. H., Zellmer, C., The, H. C., Pike, L. J., Higginson, E. E., & Baker, S. G. (2021) · The Journal of Infectious Diseases · doi:10.1093/infdis/jiab398 · Cited by 14
“5% of antimicrobials in Vietnam are provided without prescription, an issue arising in both in urban and rural areas [7].”
BackgroundCai, H. T. N., Tran, H. T., Hong, Y. N. T., Vu, G. Q. T., Tran, T. P., Bui, P. B., Hương, N. T. T., Thái, P. Q., Lai, A. T., Nuil, J. I. V., et al. (2022) · Frontiers in Public Health · doi:10.3389/fpubh.2022.822873 · Cited by 14
“Antibiotic sales from private pharmacies make up a large part of community antibiotic consumption (8) and 90% are without prescription (9).”
BackgroundSynthesizing Electronic Health Records for Predictive Models in Low-Middle-Income Countries (LMICs)
Ghosheh, G. O., Thwaites, L., & Zhu, T. (2023) · Biomedicines · doi:10.3390/biomedicines11061749 · Cited by 16
“LMICs tend to be one of the highest prescribers of antibiotics [38,39], yet they remain with limited antibiotic stewardship programs [12].”
BackgroundCost-effectiveness of Haemophilus influenzae type b vaccine in Vietnam
Le, P., Griffiths, U. K., Anh, Đ. Đ., Franzini, L., Chan, W., & Swint, J. M. (2015) · Vaccine · doi:10.1016/j.vaccine.2015.05.050 · Cited by 14
“Inappropriate antibiotic use in Vietnam due to common self-medication practices and the ease of antibiotics purchase without prescription is another important issue that probably interferes with true estimates of Hib disease incidences [48].”
BackgroundNguyen, T. A., Pham, Y. N., Phuong, N. D., Nguyen, T. H., Toàn, Đ. T. T., Vu, G. V., Marks, G. B., McKinn, S., Negin, J., Bernays, S., et al. (2021) · BMC Public Health · doi:10.1186/s12889-021-11219-4 · Cited by 14
Tran, V. D., Dorofeeva, V. V., Loskutova, E. E., Петровна, Л. Т., & Kosova, I. V. (2019) · Tropical Journal of Pharmaceutical Research · doi:10.4314/tjpr.v18i2.29 · Cited by 19
“The reasons for this selection by patients may be related to the higher costs of other public health services [10].”
BackgroundAllabi, A. C., Agbo, A. G., Boya, B., & Mudenda, S. (2023) · Pharmacology & Pharmacy · doi:10.4236/pp.2023.146014 · Cited by 14
Hong, Y. N. T., van Doorn, H. R., Nuil, J. I. V., & Lewycka, S. O. (2024) · Social Science & Medicine · doi:10.1016/j.socscimed.2024.117483 · Cited by 13
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Ahmad, T., Khan, S., Mallhi, T., Mannan, A., Rahman, A. U., Salman, M., Saleem, Z., Khan, H., Khan, Z., Karataş, Y., et al. (2023) · Journal of public health · doi:10.1007/s10389-023-02032-x · Cited by 13
“Instead, more economical generics are available, which adds an undue financial burden on public health and promotes unaffordable purchasing of incomplete dosage regimens (Nga et al. 2014).”
Substandard Quality of the Antimicrobials Sold in the Street Markets in Haiti
Jean-Baptiste, T., Carpenter, J. F., Dahl, K., Derameau, W., Veillard, R., Jacquet, J. R., Osselyn, P. L., & Figueras, A. (2020) · Antibiotics · doi:10.3390/antibiotics9070407 · Cited by 11
Tran, H. H., Nguyen, H. A. T., Tran, H. B., Vu, B. N. T., Nguyen, T., Tacoli, C., Tran, T. P., Trinh, T. S., Cai, T. H. N., Nadjm, B., et al. (2022) · Scientific Reports · doi:10.1038/s41598-022-27084-z · Cited by 10
Antibiotic resistance in fecal sludge and soil in Ho Chi Minh City, Vietnam
Schutzius, G., Nguyen, M. B., & Navab-Daneshmand, T. (2019) · Environmental Science and Pollution Research · doi:10.1007/s11356-019-06537-5 · Cited by 11
Evaluation of Antibiotic Supply Decisions by Community Pharmacists in Thailand: A Vignette Study
Donsamak, S., Weiss, M., & John, D. (2021) · Antibiotics · doi:10.3390/antibiotics10020154 · Cited by 10
“They found that there was no significant difference between Good Pharmacy Practice (GPP) certified pharmacies and non-GPP certified pharmacies regarding antibiotic supply practice [44].”
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Primary care influenza‐like illness surveillance in Ho Chi Minh City, Vietnam 2013‐2015
Todd, S., Huong, N. T. C., Thanh, N. T. L., Vy, N. H. T., Hùng, N. T., Thao, T. T. N., Phuong, H. T., van Doorn, H. R., Hang, V. T. T., Châu, N. V. V., et al. (2018) · Influenza and Other Respiratory Viruses · doi:10.1111/irv.12574 · Cited by 10
Tran, K. Q., Nguyen, T. T. D., Pham, V. H., Pham, Q. M., & Tran, H. (2023) · Advances in respiratory medicine · doi:10.3390/arm91020012 · Cited by 9
“This high antibiotic resistance may be explained by the relatively high rate of inappropriate antibiotic prescriptions in Vietnamese hospitals [33], and most antibiotics sold do not require a doctor’s prescription in many pharmacies [34].”
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Self-citationMinh, D. V., Hong, Y. N. T., Nagraj, S., Do, N. T. T., Lan, H. V. T., Nguyen, N. V., Nguyen, T. T. C., Hai, Y. N. T., Cai, H. T. N., Thi, H. T., et al. (2024) · Antimicrobial Resistance and Infection Control · doi:10.1186/s13756-024-01471-9 · Cited by 8
Self-citationAntimicrobial Resistance and the Private Sector in Southeast Asia
Liverani, M., Hashiguchi, L. O., Khan, M. S., & Coker, R. (2020) · Public health ethics analysis · doi:10.1007/978-3-030-27874-8_5 · Cited by 8
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“No significant difference was found after intervention regarding the attitude of taking antibiotics for a full course by following doctor’s advice [24].”
BackgroundOleim, S. H., Noor, S. K., Bushara, S. O., Ahmed, M. A. K., & Elmadhoun, W. M. (2019) · Sudan Journal of Medical Sciences · doi:10.18502/sjms.v14i4.5909 · Cited by 8
“Reported promoters for antibiotic misuse include lack of knowledge, absence of clear antibiotic policies and regulations, in addition to the powerful pharmaceutical marketing [9, 10].”
BackgroundResultIntroductory Chapter: Stepping into the Post-Antibiotic Era— Challenges and Solutions
Taneja, N., Sethi, S., Tahlan, A. K., & Kumar, Y. (2019) · IntechOpen eBooks · doi:10.5772/intechopen.84486 · Cited by 8
“Studies from pharmacies of Vietnam show that 90% of antimicrobials are sold without a proper prescription [34].”
Marasini, S., Sharma, S., Joshi, A., Kunwar, S., Mahato, R., Shrestha, A., & Karmacharya, B. (2024) · PLoS ONE · doi:10.1371/journal.pone.0297282 · Cited by 8
Biomarker-guided antibiotic use in primary care in resource-constrained environments
Aabenhus, R. M., & Jensen, J. S. (2016) · The Lancet Global Health · doi:10.1016/s2214-109x(16)30170-x · Cited by 7
Elhajji, F. D., Abuhasheesh, S., Rusasi, A. A., & Aldeyab, M. A. (2023) · Antibiotics · doi:10.3390/antibiotics12111576 · Cited by 7
“At the same time, low public prices of antibiotics can enhance their affordability and consumption [11].”
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“Antibiotics and painkillers are the most sold drugs across the world [53].”
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“Higher resistance to the aforementioned antibiotics in our study could be due to excessive use, misuse, and irrational prescriptions of these medications in both hospitals and community in Vietnam (35,36).”
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“A study by Nga et al. (2014) indicated that patients’ demand for antibiotics affected CPs’ antibiotic dispensing practice, making them more businessoriented, and according to them, this can be changed if patients’ awareness is improved and when the knowledge of the dispensers is sufficient to…”
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“Although Vietnamese regulations require that antibiotics be sold only with a prescription, regulations are not enforced, and approximately 90% of pharmacy antibiotic transactions are made without a prescription [4].”
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“18,49 A study by Do Thi Thuy Nga et al. (2014) reported that 100 % and 69 % of Vietnamese CPs in urban and rural areas admitted that they dispensed antibiotics due to fear of losing customers.”
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“However, although these restrictions are embedded in 2005 drug law and legal accreditation as ‘Thuc hanh tot nha thuoc’ (Good Pharmacy Practice), enforcement of this legislation is lax (Nga et al., 2014).”
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“This proportion is probably underestimated because the NPDV does not receive reports directly from patients or community pharmacies while antibiotic dispensing without prescriptions is still common in Vietnam [33].”
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“Recent studies in Vietnam estimated the share of antibiotics dispensed without prescription between 55.2% and 91% [24, 47].”
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“Patients can bypass the health care system and purchase most of the antibiotics in private pharmacies without a prescription [3].”
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“Themost frequent reason for buying antibiotics was cough and fever.(30,31) Pneumonia is not a reportable illness.”
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“Due to economic incentives for drug sellers to satisfy consumer demands and lack of knowledge on AMR from both drug sellers and consumers, many private clinics and pharmacies dispense antibiotics without prescriptions, leading to overuse and misuse of antibiotics [11].”
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“51 In Africa, the high burden of infectious diseases creates a consistently favourable market for antibiotic sales, further reinforcing this practice.”
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“Pada penggunaan antibiotik tanpa resep dokter, antibiotik yang digunakan umumnya adalah antibiotik dengan spektrum luas seperti golongan penisilin dan sefalosporin yang hingga saat ini digunakan sebagai antibiotik lini pertama untuk mengatasi berbagai infeksi(6,9,10,17,18).”
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“pada tahun 2010 hingga tahun 2030 akan terjadi peningkatan dalam penggunaan antibiotik di bidang peternakan hingga 67% dengan 99% dari peningkatan terjadi pada 5 negara dengan ekonomi terbesar yaitu Brasil, Russia, India, China, dan Afrika Selatan (BRICS).(2,3) Penyalahgunaan antibiotik pada manusia juga mengalami pen…”
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“In Vietnam, antimicrobials are widely available without prescription, and there is a culture of self-medication prior to seeking medical attention or hospitalisation [14, 15].”
Background
Metadata
- Authors
- Nga, D. T. T., Chuc, N. T. K., Hoa, N. P., Hoa, N. Q., Nguyen, N. T. T., Loan, H. T., Toan, T. K., Phuc, H. D., Horby, P., Van Yen, N., Van Kinh, N., & Wertheim, H. F.
- Affiliations
- Oxford University Clinical Research Unit (VN)
- Hanoi Medical University (VN)
- Institute of Mathematics (VN)
- University of Oxford (GB)
- Corresponding author
- Nga, Do Thi Thuy
- Nguyen, Nguyen Thi Thuy
- Venue
- BMC Pharmacology and Toxicology
- Published
- 2014-02-20
- Volume
- 15
- Issue
- 1
- Pages
- 6-6
- ISSN
- 2050-6511 (ISSN-L)
- PMC
- PMC3946644
- OpenAlex
- W2164556138
- Cited by
- 228
- References
- 23
- Citations by year
- 2026: 10 · 2025: 13 · 2024: 17 · 2023: 18 · 2022: 28 · 2021: 31 · 2020: 17 · 2019: 26 · 2018: 25 · 2017: 16 · 2016: 15 · 2015: 9 · 2014: 3
- FWCI
- 11.97
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Pharmacology and Toxicology (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Greater South Information System
- Funders
- Wellcome Trust
- Topics
- Health Sciences › Medicine › Infectious Diseases › Antibiotic Use and Resistance
- Health Sciences › Health Professions › Pharmacy › Pharmacy and Medical Practices
- Health Sciences › Nursing › Issues, ethics and legal aspects › Pharmaceutical industry and healthcare
- Keywords
- antibiotic sales, prescription drug sales, inappropriate antibiotic use, antibiotic resistance, private pharmacies, urban-rural differences, Hanoi, Vietnam
- MeSH terms
- Anti-Bacterial Agents, Commerce, Nonprescription Drugs, Health Knowledge, Attitudes, Practice, Pharmacies, Surveys and Questionnaires, Rural Population, Urban Population, Vietnam, Drug Resistance, Bacterial
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