WHO, 2014. Antimicrobial Resistance Global Report on Surveillance. Available at: http://www.who.int/drugresistance/documents/surveillancereport/en/. Accessed July 8, 2017.
Okeke IN, Laxminarayan R, Bhutta ZA, Duse AG, Jenkins P, O’Brien TF, Pablos-Mendez A, Klugman KP, 2005. Antimicrobial resistance in developing countries. Part I: recent trends and current status. Lancet Infect Dis 5: 481–493.
Okeke IN, Klugman KP, Bhutta ZA, Duse AG, Jenkins P, O’Brien TF, Pablos-Mendez A, Laxminarayan R, 2005. Antimicrobial resistance in developing countries. Part II: strategies for containment. Lancet Infect Dis 5: 568–580.
Patel G, Huprikar S, Factor SH, Jenkins SG, Calfee DP, 2008. Outcomes of carbapenem-resistant Klebsiella pneumoniae infection and the impact of antimicrobial and adjunctive therapies. Infect Control Hosp Epidemiol 29: 1099–1106.
Cisneros JM, Reyes MJ, Pachón J, Becerril B, Caballero FJ, García-Garmendía JL, Ortiz C, Cobacho AR, 1996. Bacteremia due to Acinetobacter baumannii: epidemiology, clinical findings, and prognostic features. Clin Infect Dis 22: 1026–1032.
Thamlikitkul V, 1988. Antibiotic dispensing by drug store personnel in Bangkok, Thailand. J Antimicrob Chemother 21: 125–131.
Levy SB, 2001. Antibiotic resistance: consequences of inaction. Clin Infect Dis 33 (Suppl 3): S142–S149.
Lansang MA, Lucas-Aquino R, Tupasi TE, Mina VS, Salazar LS, Juban N, Limjoco TT, Nisperos LE, Kunin CM, 1990. Purchase of antibiotics without prescription in Manila, the Philippines. Inappropriate choices and doses. J Clin Epidemiol 43: 61–67.
WHO, Regional Office for the Western Pacific, 2014. Meeting Report: Consultation for Priority Actions on Antimicrobial Resistance in the Western Pacific Region. Available at: http://iris.wpro.who.int/handle/10665.1/11344. Accessed July 8, 2017.
Metersky ML, Ma A, Bratzler DW, Houck PM, 2004. Predicting bacteremia in patients with community-acquired pneumonia. Am J Respir Crit Care Med 169: 342–347.
Driscoll AJ et al. 2017. The effect of antibiotic exposure and specimen volume on the detection of bacterial pathogens in children with pneumonia. Clin Infect Dis 64 (Suppl 3): S368–S377.
Sombrero L, Sunico ME, Quiambao B, Lucero M, Gatchalian S, Leinonen M, Ruutu P, 1999. Reliability of parental history of antibiotic use for Filipino children admitted with acute lower respiratory tract infection. Am J Trop Med Hyg 60: 397–399.
Driscoll AJ, Bhat N, Karron RA, O’Brien KL, Murdoch DR, 2012. Disk diffusion bioassays for the detection of antibiotic activity in body fluids: applications for the pneumonia etiology research for child health project. Clin Infect Dis 54 (Suppl 2): S159–S164.
Wu JJ, Chien ML, Lee N, Chou SF, Wang HM, Tsai WC, 1996. Microbiologic assay for detection of antimicrobial agents in urine. J Formos Med Assoc 95: 464–468.
Emary KR, Carter MJ, Pol S, Sona S, Kumar V, Day NP, Parry CM, Moore CE, 2015. Urinary antibiotic activity in paediatric patients attending an outpatient department in north-western Cambodia. Trop Med Int Health 20: 24–28.
Khennavong M et al. 2011. Urine antibiotic activity in patients presenting to hospitals in Laos: implications for worsening antibiotic resistance. Am J Trop Med Hyg 85: 295–302.
Murdoch DR, Woods CW, Zimmerman MD, Dull PM, Belbase RH, Keenan AJ, Scott RM, Basnyat B, Archibald LK, Reller LB, 2004. The etiology of febrile illness in adults presenting to Patan Hospital in Kathmandu, Nepal. Am J Trop Med Hyg 70: 670–675.
Liu YC, Huang WK, Huang TS, Kunin CM, 1999. Extent of antibiotic use in Taiwan shown by antimicrobial activity in urine. Lancet 354: 1360.
The World Bank, 2016. The World Bank Countries and Economies Philippines. Available at: http://data.worldbank.org/country/philippines. Accessed July 8, 2017.
Covvey JR, Johnson BF, Elliott V, Malcolm W, Mullen AB, 2014. An association between socioeconomic deprivation and primary care antibiotic prescribing in Scotland. J Antimicrob Chemother 69: 835–841.
Wise J, 2015. Antibiotic prescribing is higher in deprived areas of England. BMJ 351: h6117.
Obaro S et al. 2011. Community acquired bacteremia in young children from Central Nigeria—a pilot study. BMC Infect Dis 11: 137.
Jorgji K, Bebeci E, Apostoli P, Apostoli A, 2014. Evaluation of use of antibiotics without prescription among young adults in Albania case study: Tirana and Fier district. Hippokratia 18: 217–220.
Scott JA et al. 2000. Aetiology, outcome, and risk factors for mortality among adults with acute pneumonia in Kenya. Lancet 355: 1225–1230.
Catalano M, Almiron MA, Romeo AM, Caruso E, Murtagh P, Harisiadi J, 1990. Comparison between parental report and results of microbiologic agar assay for presence of antibiotic in urine of Argentinian children with acute lower respiratory tract infection. Rev Infect Dis 12 (Suppl 8): S998–S1000.
Ghafoor A, Nomani NK, Ishaq Z, Zaidi SZ, Anwar F, Burney MI, Qureshi AW, Ahmad SA, 1990. Diagnoses of acute lower respiratory tract infections in children in Rawalpindi and Islamabad, Pakistan. Rev Infect Dis 12 (Suppl 8): S907–S914.
Hortal M, Mogdasy C, Russi JC, Deleon C, Suarez A, 1990. Microbial agents associated with pneumonia in children from Uruguay. Rev Infect Dis 12 (Suppl 8): S915–S922.
Tupasi TE, Lucero MG, Magdangal DM, Mangubat NV, Sunico ME, Torres CU, de Leon LE, Paladin JF, Baes L, Javato MC, 1990. Etiology of acute lower respiratory tract infection in children from Alabang, Metro Manila. Rev Infect Dis 12 (Suppl 8): S929–S939.
Abu Shaqra QM, 2001. Antimicrobial activity in urine: effect on leukocyte count and bacterial culture results. New Microbiol 24: 137–142.
Rhodes J et al. 2010. Antibiotic use in Thailand: quantifying impact on blood culture yield and estimates of pneumococcal bacteremia incidence. Am J Trop Med Hyg 83: 301–306.
Berkley JA et al. 2005. Bacteremia among children admitted to a rural hospital in Kenya. N Engl J Med 352: 39–47.
Liu YC, Huang WK, Huang TS, Kunin CM, 1999. Detection of antimicrobial activity in urine for epidemiologic studies of antibiotic use. J Clin Epidemiol 52: 539–545.
Moïsi JC et al. 2009. Enhanced diagnosis of pneumococcal meningitis with use of the Binax NOW immunochromatographic test of Streptococcus pneumoniae antigen: a multisite study. Clin Infect Dis 48 (Suppl 2): S49–S56.
WHO, 2009. Dengue: Guidelines for Diagnosis, Treatment, Prevention and control: New Edition. Geneva, Switzerland: World Health Organization. Available at: http://www.who.int/rpc/guidelines/9789241547871/en/. Accessed July 8, 2017.
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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.
Financial support: The study was funded by the Ministry of Education, Culture, Sports, Science and Technology, and the Government of Japan. The funders had no role in the study design, data collection and analysis, decision to publish, or reparation of the article.
Disclosure: Part of this work was submitted as a Master of Tropical Medicine thesis by Dr. Noriko Takamura, School of Tropical Medicine and Global Health, Nagasaki University, Japan. This work was presented in part at American Society of Tropical Medicine Meeting, November 2016.
Authors’ addresses: Nobuo Saito, Noriko Takamura, Paul S. Solano, Cherlyn D. Ubas, Arianne V. Lintag, Motoi Suzuki, and Koya Ariyoshi, Department of Clinical Tropical Medicine, School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan, E-mails: nobuosaito@nagasaki-u.ac.jp, ntakamura84@gmail.com, paul_solano03@yahoo.com, cherlyn_41391@yahoo.com, ayhanpatricia19@yahoo.com, mosuzuki@nagasaki-u.ac.jp, and kari@nagasaki-u.ac.jp. Grace P. Retuerma, Carina H. Frayco, Maricel R. Ribo, Rontgene M. Solante, Alexis Q. Dimapilis, Elizabeth O. Telan, and Winston S. Go, San Lazaro Hospital, Manila, Philippines, E-mails: graceretuerma@gmail.com, chfmd1179@gmail.com, maricelregino_ribo74@yahoo.com, rontgenes@hotmail.com, virginia.dimapilis@yahoo.com, betelan@yahoo.com, and wsgo.doh@gmail.com. Christopher M. Parry, Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom, E-mail: christopher.parry@lstmed.ac.uk.
WHO, 2014. Antimicrobial Resistance Global Report on Surveillance. Available at: http://www.who.int/drugresistance/documents/surveillancereport/en/. Accessed July 8, 2017.
Okeke IN, Laxminarayan R, Bhutta ZA, Duse AG, Jenkins P, O’Brien TF, Pablos-Mendez A, Klugman KP, 2005. Antimicrobial resistance in developing countries. Part I: recent trends and current status. Lancet Infect Dis 5: 481–493.
Okeke IN, Klugman KP, Bhutta ZA, Duse AG, Jenkins P, O’Brien TF, Pablos-Mendez A, Laxminarayan R, 2005. Antimicrobial resistance in developing countries. Part II: strategies for containment. Lancet Infect Dis 5: 568–580.
Patel G, Huprikar S, Factor SH, Jenkins SG, Calfee DP, 2008. Outcomes of carbapenem-resistant Klebsiella pneumoniae infection and the impact of antimicrobial and adjunctive therapies. Infect Control Hosp Epidemiol 29: 1099–1106.
Cisneros JM, Reyes MJ, Pachón J, Becerril B, Caballero FJ, García-Garmendía JL, Ortiz C, Cobacho AR, 1996. Bacteremia due to Acinetobacter baumannii: epidemiology, clinical findings, and prognostic features. Clin Infect Dis 22: 1026–1032.
Thamlikitkul V, 1988. Antibiotic dispensing by drug store personnel in Bangkok, Thailand. J Antimicrob Chemother 21: 125–131.
Levy SB, 2001. Antibiotic resistance: consequences of inaction. Clin Infect Dis 33 (Suppl 3): S142–S149.
Lansang MA, Lucas-Aquino R, Tupasi TE, Mina VS, Salazar LS, Juban N, Limjoco TT, Nisperos LE, Kunin CM, 1990. Purchase of antibiotics without prescription in Manila, the Philippines. Inappropriate choices and doses. J Clin Epidemiol 43: 61–67.
WHO, Regional Office for the Western Pacific, 2014. Meeting Report: Consultation for Priority Actions on Antimicrobial Resistance in the Western Pacific Region. Available at: http://iris.wpro.who.int/handle/10665.1/11344. Accessed July 8, 2017.
Metersky ML, Ma A, Bratzler DW, Houck PM, 2004. Predicting bacteremia in patients with community-acquired pneumonia. Am J Respir Crit Care Med 169: 342–347.
Driscoll AJ et al. 2017. The effect of antibiotic exposure and specimen volume on the detection of bacterial pathogens in children with pneumonia. Clin Infect Dis 64 (Suppl 3): S368–S377.
Sombrero L, Sunico ME, Quiambao B, Lucero M, Gatchalian S, Leinonen M, Ruutu P, 1999. Reliability of parental history of antibiotic use for Filipino children admitted with acute lower respiratory tract infection. Am J Trop Med Hyg 60: 397–399.
Driscoll AJ, Bhat N, Karron RA, O’Brien KL, Murdoch DR, 2012. Disk diffusion bioassays for the detection of antibiotic activity in body fluids: applications for the pneumonia etiology research for child health project. Clin Infect Dis 54 (Suppl 2): S159–S164.
Wu JJ, Chien ML, Lee N, Chou SF, Wang HM, Tsai WC, 1996. Microbiologic assay for detection of antimicrobial agents in urine. J Formos Med Assoc 95: 464–468.
Emary KR, Carter MJ, Pol S, Sona S, Kumar V, Day NP, Parry CM, Moore CE, 2015. Urinary antibiotic activity in paediatric patients attending an outpatient department in north-western Cambodia. Trop Med Int Health 20: 24–28.
Khennavong M et al. 2011. Urine antibiotic activity in patients presenting to hospitals in Laos: implications for worsening antibiotic resistance. Am J Trop Med Hyg 85: 295–302.
Murdoch DR, Woods CW, Zimmerman MD, Dull PM, Belbase RH, Keenan AJ, Scott RM, Basnyat B, Archibald LK, Reller LB, 2004. The etiology of febrile illness in adults presenting to Patan Hospital in Kathmandu, Nepal. Am J Trop Med Hyg 70: 670–675.
Liu YC, Huang WK, Huang TS, Kunin CM, 1999. Extent of antibiotic use in Taiwan shown by antimicrobial activity in urine. Lancet 354: 1360.
The World Bank, 2016. The World Bank Countries and Economies Philippines. Available at: http://data.worldbank.org/country/philippines. Accessed July 8, 2017.
Covvey JR, Johnson BF, Elliott V, Malcolm W, Mullen AB, 2014. An association between socioeconomic deprivation and primary care antibiotic prescribing in Scotland. J Antimicrob Chemother 69: 835–841.
Wise J, 2015. Antibiotic prescribing is higher in deprived areas of England. BMJ 351: h6117.
Obaro S et al. 2011. Community acquired bacteremia in young children from Central Nigeria—a pilot study. BMC Infect Dis 11: 137.
Jorgji K, Bebeci E, Apostoli P, Apostoli A, 2014. Evaluation of use of antibiotics without prescription among young adults in Albania case study: Tirana and Fier district. Hippokratia 18: 217–220.
Scott JA et al. 2000. Aetiology, outcome, and risk factors for mortality among adults with acute pneumonia in Kenya. Lancet 355: 1225–1230.
Catalano M, Almiron MA, Romeo AM, Caruso E, Murtagh P, Harisiadi J, 1990. Comparison between parental report and results of microbiologic agar assay for presence of antibiotic in urine of Argentinian children with acute lower respiratory tract infection. Rev Infect Dis 12 (Suppl 8): S998–S1000.
Ghafoor A, Nomani NK, Ishaq Z, Zaidi SZ, Anwar F, Burney MI, Qureshi AW, Ahmad SA, 1990. Diagnoses of acute lower respiratory tract infections in children in Rawalpindi and Islamabad, Pakistan. Rev Infect Dis 12 (Suppl 8): S907–S914.
Hortal M, Mogdasy C, Russi JC, Deleon C, Suarez A, 1990. Microbial agents associated with pneumonia in children from Uruguay. Rev Infect Dis 12 (Suppl 8): S915–S922.
Tupasi TE, Lucero MG, Magdangal DM, Mangubat NV, Sunico ME, Torres CU, de Leon LE, Paladin JF, Baes L, Javato MC, 1990. Etiology of acute lower respiratory tract infection in children from Alabang, Metro Manila. Rev Infect Dis 12 (Suppl 8): S929–S939.
Abu Shaqra QM, 2001. Antimicrobial activity in urine: effect on leukocyte count and bacterial culture results. New Microbiol 24: 137–142.
Rhodes J et al. 2010. Antibiotic use in Thailand: quantifying impact on blood culture yield and estimates of pneumococcal bacteremia incidence. Am J Trop Med Hyg 83: 301–306.
Berkley JA et al. 2005. Bacteremia among children admitted to a rural hospital in Kenya. N Engl J Med 352: 39–47.
Liu YC, Huang WK, Huang TS, Kunin CM, 1999. Detection of antimicrobial activity in urine for epidemiologic studies of antibiotic use. J Clin Epidemiol 52: 539–545.
Moïsi JC et al. 2009. Enhanced diagnosis of pneumococcal meningitis with use of the Binax NOW immunochromatographic test of Streptococcus pneumoniae antigen: a multisite study. Clin Infect Dis 48 (Suppl 2): S49–S56.
WHO, 2009. Dengue: Guidelines for Diagnosis, Treatment, Prevention and control: New Edition. Geneva, Switzerland: World Health Organization. Available at: http://www.who.int/rpc/guidelines/9789241547871/en/. Accessed July 8, 2017.
Past two years | Past Year | Past 30 Days | |
---|---|---|---|
Abstract Views | 796 | 564 | 44 |
Full Text Views | 1587 | 17 | 3 |
PDF Downloads | 584 | 17 | 3 |