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

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 aprospective observational study from February 2, 2015, to July 2, 2015, we enrolled febrile patients attending theemergency room in San Lazaro Hospital, Manila, the Philippines.Aurine sample was collected and a bioassay was used todetect antibiotic activity in urine using Bacillus stearothermophilus (ATCC7953), Escherichia coli (ATCC25922), andStreptococcus pyogenes (ATCC19615). Patients or caregivers reported their medication history, clinical information, andsocioeconomic 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 wasthe 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 lowestincome 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 unnecessaryantibiotic use