The challenges of combatting antimicrobial resistance in the Philippines
Authors: Janine Patricia G Robredo, Michelle Ann B Eala, Joseph Alexander Paguio, Maria Sonia S Salamat, Leo Anthony G Celi
Journal: The Lancet Microbe (2022)

The Lancet Microbe1Antimicrobial resistance is part of a perfect storm of health.Lancet Microbe. 2021; 2: e645Google Scholar highlighted antimicrobial resistance as a critical yet often overlooked threat to public health. Global inequalities in access to antimicrobials, paucity of data from low-income and middle-income countries (LMICs),2Pokharel S Raut S Adhikari B Tackling antimicrobial resistance in low-income and middle-income countries.BMJ Glob Health. 2019; 4e002104Google Scholar where antimicrobial resistance is a looming crisis, and perfunctory, if not absent, antibiotic stewardship in most resource-limited tertiary care centres require an urgent response from the international community. In the Philippines, a lower–middle income country in southeast Asia, cultural misconceptions and inadequate regulation and enforcement of antibiotic use have shaped provider and patient attitudes and behaviour. Self-medication is rampant in the Philippines, with a prevalence of 31–66%.3Barber DA Casquejo E Ybañez PL et al.Prevalence and correlates of antibiotic sharing in the Philippines: antibiotic misconceptions and community-level access to non-medical sources of antibiotics.Trop Med Int Health. 2017; 22: 567-575Google Scholar Self-medication provides some semblance of health care, especially for low-income households that avoid economic and opportunity costs (ie, productive work hours compromised by long clinic wait times) of medical consultation and diagnostics.5Ayukekbong J Ntemgwa M Atabe A The threat of antimicrobial resistance in developing countries: causes and control strategies.Antimicrob Resist Infect Control. 2017; 6: 47Google Scholar Self-medication is also common among higher-income earners in LMICs, who have easier access to health information, and have the financial and social means to acquire medicine. Non-medical professionals commonly prescribe antimicrobials, and antibiotic sharing remains a common practice among Filipino families and communities. Such practices reflect poor regulation of dispensaries in the country. Culture also substantially impacts health behaviour, and many Filipino people in rural areas still seek first-line treatment from traditional healers.4Mallah N Orsini N Figueiras A Takkouche B Income level and antibiotic misuse: a systematic review and dose-response meta-analysis.Eur J Health Econ. 2021; (published online Nov 30.)https://doi.org/10.1007/s10198-021-01416-8Google Scholar These healers provide unknown herbal treatments—with some containing suboptimal levels of antibiotics, which might later enhance pathogen resistance—and perform outdated practices, such as crushing antibiotics to apply to skin injuries.2Pokharel S Raut S Adhikari B Tackling antimicrobial resistance in low-income and middle-income countries.BMJ Glob Health. 2019; 4e002104Google Scholar Finally, education of the public is crucial. A study showed that 29–95% of adults had various misconceptions about the indications, instructions of use, and side-effects of antibiotics.4Mallah N Orsini N Figueiras A Takkouche B Income level and antibiotic misuse: a systematic review and dose-response meta-analysis.Eur J Health Econ. 2021; (published online Nov 30.)https://doi.org/10.1007/s10198-021-01416-8Google Scholar Many people fail to realise the causative role of improper use and non-adherence in antimicrobial resistance, and the impact on future health costs. Antimicrobial resistance requires solutions tailored to its specific drivers and necessitates an intersectoral approach. Government legislation is crucial to regulate antibiotic prescription and dispensation and ensure accessibility and affordability of antimicrobials.2Pokharel S Raut S Adhikari B Tackling antimicrobial resistance in low-income and middle-income countries.BMJ Glob Health. 2019; 4e002104Google Scholar Partnerships between academic and private sectors are needed to understand local antimicrobial resistance patterns and design culturally appropriate solutions. Public education on antimicrobial resistance must involve health-care providers, public health experts, and community leaders, especially from rural regions, to tackle the challenges of conveying medical information in lay language.4Mallah N Orsini N Figueiras A Takkouche B Income level and antibiotic misuse: a systematic review and dose-response meta-analysis.Eur J Health Econ. 2021; (published online Nov 30.)https://doi.org/10.1007/s10198-021-01416-8Google Scholar Finally, the creation of global health networks to share best practices in addressing antimicrobial resistance in LMICs like the Philippines will help advance the global goal of eradication. We declare no competing interests. Antimicrobial resistance is part of a perfect storm of health crisesOften events designed to raise the profile of particular health issues or diseases are accompanied by statements measuring progress over the past year or so. For World Antimicrobial Awareness Week (WAAW), Nov 18–24, the message is somewhat simpler: know that antimicrobial resistance (AMR) exists and treat antimicrobials as the precious resource that they are. In a WHO video announcing WAAW, WHO Director-General Tedros Adhanom Ghebreyesus rightly states that AMR is "one of the greatest health threats humanity faces today" and that antimicrobials "are the backbone of modern medicine". Full-Text PDF Open Access