Antibiotic Resistance in the Philippines: A Public Health Crisis and Call for Urgent Action

Abstract

The perspective titled “Perspective on Antibiotic Resistance in Bangladesh: A Critical Yet Overlooked Public Health Crisis” by Md. Mahadi Hassan and Noushin Nohor provides an important insight on antibiotic resistance (AR) in Bangladesh that requires urgent attention [1]. This correspondence aims to elucidate the factors contributing to AR in the Philippines and propose public health interventions, informed by global and regional insights, to mitigate its impact.

AR refers to the ability of bacteria to survive and proliferate despite the administration of antibiotics designed to kill or inhibit them [2]. Resistance mechanisms include genetic mutations, horizontal gene transfer, and alterations in bacterial cell processes that neutralize the drug's efficacy [2]. Globally, AR is linked to ~1.27 million deaths in 2019 and contributed to 4.95 million deaths. The World Health Organization (WHO) research agenda for antimicrobial resistance (AMR) in human health has identified 40 research priorities to be addressed by the year 2030 [2].

The Philippines, as a developing country in Southeast Asia, experiences an exacerbated AR crisis due to widespread misuse of antibiotics, insufficient regulatory enforcement, and limited public awareness [3]. AR jeopardizes treatment outcomes, increases healthcare costs, and undermines national health security. First, the irrational use of antibiotics is a significant driver of AR in the Philippines. With a prevalence of 31%–66%, self-medication is prevalent in the Philippines [3]. Widespread prescription of antibiotics without definitive diagnostic testing is common, with antibiotics often being used to treat viral infections, such as the common cold, despite their ineffectiveness. In addition, incomplete antibiotic courses are frequently observed, often due to financial constraints or the misconception that improvement equates to cure [3].

Second, self-medication and over-the-counter access to antibiotics worsen the problem. Antibiotics are widely available in pharmacies without prescriptions, promoting cost-driven self-medication and misuse due to lack of awareness, which fuels the rise of resistant bacterial strains [3]. Third, agricultural practices contribute significantly to AR. Antibiotics are commonly used as growth promoters in livestock farming, and residues in meat products can transfer resistance to humans through the food chain [4]. During the COVID-19 pandemic, the Food and Drug Administration (FDA) warned against using Ivermectin veterinary products for COVID-19, emphasizing that Ivermectin is not FDA-approved for treating viral infections.

Given the current difficulties faced by Filipino people, Hassan and Nohor's study is relevant in the Philippine setting. The AR scenario in Bangladesh shares similarities with the Philippines, including the prevalence of self-medication and the misuse of antibiotics in agriculture. Bangladesh has initiated nationwide surveillance and adopted “One Health” initiatives that emphasize the interconnectedness of human, animal, and environmental health [1]. These initiatives highlight the need for similar frameworks in the Philippines. Learning from Bangladesh's challenges and successes can guide the formulation of contextualized interventions in the Philippines.

First, the Philippine Department of Health (DOH) should strengthen its antimicrobial stewardship. Hospitals and healthcare facilities should adopt antimicrobial stewardship programs (ASPs) to ensure evidence-based antibiotic use. These programs can train healthcare workers, establish prescribing guidelines, and implement monitoring systems. Second, surveillance is another key priority. Expanding the scope of the Antimicrobial Resistance Surveillance Program (ARSP) to cover all regions is critical. Regular reporting and integration with global AR networks will improve response capabilities. Third, public education campaigns are essential to raise awareness about the dangers of AR and the importance of responsible antibiotic use. Mass media and school-based programs, along with behavioral change communication strategies, should target specific groups, including farmers, healthcare providers, and the youth.

Lastly, policy reforms are necessary to address AR effectively. Regulatory measures, such as mandatory prescriptions for antibiotics and stricter monitoring of agricultural antibiotic use, should be enforced. Collaboration with the Department of Agriculture can promote alternatives like vaccines and probiotics in livestock farming. The “One Health” approach should be embraced. Recognizing the interconnection between human, animal, and environmental health, the Philippines should adopt a multisectoral strategy. Partnerships between public health authorities, agricultural agencies, and environmental organizations can foster sustainable solutions [5].

AR in the Philippines is a critical public health challenge that demands urgent attention and collaborative action. A coordinated response focusing on antimicrobial stewardship, robust surveillance, public education, and comprehensive policy reforms is essential to protect future generations and ensure the sustainability of healthcare systems. Moving forward, strategies to enhance data preparation, integrate more actionable data, and incorporate systematic literature reviews will improve the quality and depth of analyses. Implementing targeted policies to strengthen AR surveillance and linking outcomes with resistance data will refine research efforts and inform evidence-based interventions. Expanding the quantity and quality of data both locally and globally will enable future studies to better assess the impact of AR and provide effective approaches to combat the escalating threat of AR.

Jeff Clyde G Corpuz: conceptualization, writing – original draft, visualization, writing – review and editing, formal analysis.

It was a study of general information that was accessible online. There was no need for ethical approval.

The author declares no conflicts of interest.