SIEM REAP – A campaign to draw attention to antibiotics misuse was launched using circus performers to get the message across.

Excessive use of the drugs is leading to the global health issue of microbial resistance. If unaddressed, developing new drugs will become more expensive, campaign manager Rashaad Wijntuin says.

He said Cambodian awareness of antibiotic misuse is lacking and called for regulations to restrict self-prescription.

Wijntuin, a student in Health Sciences specializing in International Public Health from the Netherlands, came to Cambodia to learn and raise awareness of the use of antibiotics and their harmful effects if used improperly.

His involvement was through the Electronic Clinical Decision Support for Acute Fever Management (EDAM) project run by the Mahidol Oxford Tropical Medicine Research Unit (MORU) in Thailand. About fifty individuals are working on the project from MORU Bangkok, Action for Health Development (AHEAD), COMRU Cambodia, Phare Ponleu Selpak, and the National Centre for Parasitology, Entomology, and Malaria Control (CNM), with assistance from the provincial health departments.

“There was a study that showed that almost nobody knew about antimicrobial resistance, and that just general knowledge about antibiotic use in Cambodia is at a very simple scale,” he said. 

“When I first came here, one of the things that I noticed immediately was just the number of pharmacies that are everywhere around the city. It's more pharmacies than grocery stores, actually.” 

To reach more young people, Wijntuin opted for circus comedy entertainment to convey the message of antimicrobial resistance and the proper consumption of antibiotics with prescriptions from hospitals and healthcare centers. 

Performances with the Phare circus group took place last month in Battambang and Siem Reap.

To tour the whole country is expensive, prompting him to choose only Battambang and Siem Reap, where researchers from MORU had conducted a study for the EDAM project with health authorities.

“The performers of Phare had a rough idea of what we wanted to do,” he said.

“The performances were successful and the team was straightforward in conveying the intended messages. The team's efforts were appreciated, and the performers were praised for their great job.”

EDAM project coordinator in Cambodia, Phal Chanpheakdey, said MORU’s study of 5000 people two years ago revealed that many lack awareness about antibiotic use, prescribe drugs themselves, and buy drugs without proper hospital diagnoses. The analysis has not yet been released, he said.

MORU conducted a trial study in Battambang province, involving 30 healthcare centers where the medical staff are equipped with trial mobile app.

This can diagnose diseases and issue a prescription. The study was divided into two parts, with 15 medical centers each. 

Center staff use the app to diagnose the disease, and they then prescribe for the patients, while the other 15 centers use the app for both diagnosis and prescription.

“The results are in analysis,” he said. “If the app is good, we’ll let medical personnel in developing countries in Africa or Asia use this mobile app.”

Chanpheakdey said it would be hard to compare antibiotic use in Cambodia and other countries but Thailand prohibits buying without a prescription, limiting access to certain high-potency variants of pain killers such as Acetaminophen.

In Thailand, pharmaceutical products are categorized into three groups: Over-the-counter (OTC), prescription, and traditional and complementary medicines. 

OTC drugs are self-treatment medications like paracetamol and antacids, while prescription drugs require a doctor's prescription and are more potent and carry higher risks. These include antibiotics for bacterial infections and antidepressants for mental health conditions.

Traditional and complementary medicines such as herbal remedies and herbal capsules are regulated separately to acknowledge their traditional use and limited risk. 

Kros Sarath, director of the Siem Reap Health Department, acknowledged people’s wrong attitudes to antibiotic use, warning that carelessness and improper consumption of antibiotics can lead to death.

“When you use too much antibiotic, it won’t kill the disease but could kill you,” he said.

Phal Chanpheakdey said it would take a long time for Cambodia to have such a regulation to control drug purchases and consumption if all stakeholders work together, including the Health Ministry.

“The problem is that the pharmacists prioritize money over people’s health,” he said. 

“It would become a rooted problem if we don’t address it sooner. However, we cannot completely ban the purchase of antibiotics at the pharmacy, as we still need them in an emergency.”

Antimicrobial resistance (AMR) threatens public health, causing 5.2 million deaths in the World Health Organization Western Pacific Region.

Cambodia's misuse and overuse of antibiotics is largely due to non-prescription use, particularly for respiratory infections and diarrhea in children, and limited control over sales. 

According to a study in 2021, 2005 participants in Phnom Penh, Siem Reap, and Prey Veng were highly aware of antibiotics (86.5%) and antibiotic resistance (58.4%), but only 1.2% understood that antibiotics are effective only against bacterial infections.