Frequent Community Use of Antibiotics among a Low-Economic Status Population in Manila, the Philippines: A Prospective Assessment Using a Urine Antibiotic Bioassay.



Saito, Nobuo, Takamura, Noriko, Retuerma, Grace P, Frayco, Carina H, Solano, Paul S, Ubas, Cherlyn D, Lintag, Arianne V, Ribo, Maricel R, Solante, Rontgene M, Dimapilis, Alexis Q
et al (show 5 more authors) (2018) Frequent Community Use of Antibiotics among a Low-Economic Status Population in Manila, the Philippines: A Prospective Assessment Using a Urine Antibiotic Bioassay. The American Journal of Tropical Medicine and Hygiene, 98 (5). 1512 - 1519.

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Abstract

The widespread unregulated use of antibiotics without medical consultation contributes to the burden of antibiotic resistance in Southeast Asian countries. This study investigated antibiotic use before hospital consultation. In a prospective observational study from February 2, 2015, to July 2, 2015, we enrolled febrile patients attending the emergency room in San Lazaro Hospital, Manila, the Philippines. A urine sample was collected and a bioassay was used to detect antibiotic activity in urine using Bacillus stearothermophilus (ATCC7953), Escherichia coli (ATCC25922), and Streptococcus pyogenes (ATCC19615). Patients or caregivers reported their medication history, clinical information, and socioeconomic status. During the study period, 410 patients were enrolled. The median (interquartile range) age was 14 (7-23) years and 158 (39%) reported prior antibiotic use, predominantly a beta-lactam antibiotic. A total of 164 (40%, 95% confidence interval [CI]: 35-45) patients were urine bioassay positive with any of three organisms. The Bacillus assay was the most sensitive, detecting 162 (99%, 95% CI: 96-100) cases. Among bioassay positive patients, dengue (N = 91, 55%, 95% CI: 48-63) was the most frequent diagnosis, followed by other viral infections, including measles, rubella, and mumps (N = 17, 10%, 95% CI: 6-16). Patients with a positive bioassay were significantly more likely to be from the lowest-income group (adjusted odds ratio [AOR]: 1.7; 95% CI: 1.1-2.6) and required hospital admission (AOR: 2.1; 95% CI: 1.3-3.5). Unnecessary antibiotic use for febrile illnesses before hospital consultation is common in a low-income, highly populated urban community in Manila. Education targeting this group should be implemented to reduce unnecessary antibiotic use.

Item Type: Article
Uncontrolled Keywords: Humans, Anti-Bacterial Agents, Biological Assay, Prospective Studies, Poverty, Adolescent, Adult, Aged, Middle Aged, Child, Child, Preschool, Infant, Infant, Newborn, Urban Population, Drug Utilization, Philippines, Female, Male, Young Adult, Economic Status
Depositing User: Symplectic Admin
Date Deposited: 21 Oct 2019 07:30
Last Modified: 20 Jan 2020 14:11
DOI: 10.4269/ajtmh.17-0564
URI: http://livrepository.liverpool.ac.uk/id/eprint/3058835