Special Report & Cambodia: Antibiotics Over the Counter, Resistance on the Ward
A fever, a sore throat, and the village pharmacy sells a few capsules without a prescription. Several studies published in 2026 show the habit has not faded. In hospitals, bacteria are increasingly resistant to basic treatments, even in very young children.
Siem Pang, 2026: antibiotics sold as a service
Siem Pang is a rural district of Stung Treng province, in the country's northeast. A team from the Mahidol-Oxford Tropical Medicine Research Unit carried out 30 in-depth interviews there with residents, drug sellers and health workers. The study was published on 1 October 2026 in BMC Medical Ethics.
The findings are clear. Residents have a poor grasp of how antibiotics work and little idea of what resistance means. The health centre is expensive and far away. The local seller is right there. People see the risks, but access wins.
Informal sellers do not see themselves as doing wrong. They describe selling antibiotics as socially responsible, or as an economic necessity. For the researchers, a lack of knowledge and financial pressure lead everyone to put the family's immediate need ahead of the collective risk.
One feverish child in two is given antibiotics
In February 2026, paediatricians from Korea University, working with the National Paediatric Hospital in Phnom Penh, published an analysis of Cambodia's Demographic and Health Surveys in Infection & Chemotherapy. These national surveys cover 7,000 to 8,000 children under five in each round.
The good news first: children are falling ill less often. Between 2010 and 2021-2022, the share of under-fives who had a fever in the previous two weeks fell from 26.8% to 13.2%. Diarrhoea dropped from 14.5% to 6.9%.
Antibiotic use has not followed. In 2021-2022, 53% of fever episodes and 29% of diarrhoea episodes were treated with antibiotics. Urban children receive them more often than rural children. The authors put this down to easy access through private pharmacies and informal sellers.
None of this is new. As far back as 2013, researchers from the University of New South Wales described drug “cocktails” sold by the dose, including two capsules of amoxicillin for a common cold. One patient's relative told them: “If I have money I buy medicines, to take two doses.” Without money, it was a single dose. The 2026 studies describe the same logic.
Antibiotic resistance: 88% of young patients are carriers
The most striking figure comes from Siem Reap. A study published in April 2026 in Antimicrobial Resistance and Infection Control followed 605 children under five seen at Angkor Hospital for Children in 2021-2022. On arrival, 88% carried gut bacteria resistant to third-generation cephalosporins, a widely used family of antibiotics. Another 3% carried bacteria resistant to carbapenems, the drugs of last resort. Of the E. coli isolated, 68% were multidrug-resistant.
Carrying these bacteria does not mean being ill. But they can cause infections that are hard to treat. The authors note that their detection method, more sensitive than in the past, and recruitment at a hospital may push this rate above that of the general population. Six months of follow-up also showed that hospital stays and antibiotic use made it easier to pick up resistant Klebsiella.
Serious infections tell the same story. In November 2025, the WHO's Western Pacific surveillance journal published data from Battambang Provincial Referral Hospital, a sentinel site in the national network. Between 2020 and 2022, 74% of E. coli found in the blood were resistant to ceftriaxone, and one in three Staphylococcus aureus to methicillin. The country's eight sentinel sites reported the same 74% rate to the WHO for 2022. Thailand reported 34% and Laos 53%.
The rise goes back years. Between 2012 and 2015, the Institut Pasteur du Cambodge saw the share of ESBL-producing E. coli, enzymes that disable penicillins and cephalosporins, climb from 28.9% to 48.2%. Worldwide, nearly 5 million deaths in 2019 were linked to resistant bacteria, according to an estimate published in The Lancet.
On the farms, multidrug-resistant Salmonella
In April 2025, Veterinary World published a study carried out on small and medium-sized commercial pig and poultry farms. Salmonella was uncommon: 6.6% of animals with diarrhoea carried it. But 91% of strains isolated from poultry (21 of 23) were multidrug-resistant, against 53% in pigs (10 of 19). The samples are small. The authors call for tighter control of antibiotic use in livestock and stronger surveillance.
These results build on earlier work. In 2016, the Institut Pasteur found ESBL-producing E. coli on about 60% of pork, chicken and fish samples bought at two Phnom Penh markets. Many were resistant to amphenicols, banned in human medicine in Cambodia but still given to animals.
In 2018, a study of 91 small pig farms around the capital found that two farmers in three adjusted doses and treatment length themselves. 45% had never heard of antimicrobial resistance.
National plan 2025-2029: Cambodia tackles antimicrobial resistance
Cambodia now has a new multisectoral action plan on antimicrobial resistance for 2025-2029. The WHO published it on 26 February 2026. It follows a first plan for 2019-2023, led by the ministries of Health, Agriculture and Environment. A hospital surveillance network has been running since 2017 with eight sentinel sites.
Awareness campaigns are also trying new channels. In September 2026, the journal International Health described a project that uses circus arts to talk about antimicrobials with the public. Its authors start from the same observation: understanding of these medicines remains limited, and over-the-counter antibiotics are everywhere.
That leaves the village counter. The Siem Pang researchers draw a practical conclusion: action is needed both on sellers' economic incentives and on families' lack of information.
Good habits
• Antibiotics do not work on viruses. They do not treat colds, flu or dengue.
• Antibiotics should be taken on prescription, at the dose and for the length of time indicated. One or two capsules cure nothing.
• Do not keep leftovers or share them.
• A fever that lasts more than a few days calls for a consultation, not another bag of pills from the pharmacy.
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