ANTIBIOTICS OVER THE COUNTER: AN INVESTIGATION ON ANTIBIOTIC

DISPENSATION WITHOUT A PRESCRIPTION OF LOCAL DRUGSTORE

A Thesis Paper
Presented to
The Biology Department
Our Lady of Fatima University

In Partial Fulfillment
of the Requirements for the Degree
Bachelor of Science in Biology

Jemimah Chan
Ela Sophia B. Khu
Sean Ashley R. Laborte
Keem Bryan A.Pornobi
Jenalyn B. Rubante
Mary Ann Tesorero
March 2023
 APPROVAL SHEET

This is to certify that this Thesis titled, “ANTIBIOTICS OVER THE COUNTER: AN
INVESTIGATION ON ANTIBIOTIC DISPENSATION WITHOUT A
PRESCRIPTION OF LOCAL DRUGSTORE” was prepared and submitted by
Jemimah Chan, Ela Sophia B. Khu, Sean Ashley R. Laborte , Keem Bryan A. Pornobi,
Jenalyn B. Rubante, Mary Ann Tesorero In Partial Fulfillment of the Requirements for
the Degree Bachelor of Science in Biology, is hereby recommended for Oral
Examination.

ERNESTO B. GUEVARRA, MD, MPH

Adviser

PANEL OF EXAMINERS
Examined and approved by the Panel of Examiners in an Oral Examination with a Grade
of ____ on __________ _____, 2023.

Chairperson
Member
Member

Accepted as partial fulfillment of the requirements for Biological Research(BIOR 411)

Dean of College of Arts and Sciences

 CERTIFICATE OF ORIGINALITY

I hereby certify that this Thesis is our work and that, to the best of our knowledge
and belief, and it contains no material previously written or published by another person
or organization or any material which has been accepted for the award of any other
degree or diploma from a university or institution of higher learning except where due
acknowledgement is made there of.

Furthermore, we declare that the intellectual content of this research is the product
of our work although we have received assistance from others on the manner of
organization, presentation, language, and style.

Jemimah Chan, Ela Sophia B. Khu, Sean Ashley R. Laborte , Keem Bryan A. Pornobi,

Jenalyn B. Rubante, Mary Ann Tesorero

Candidates

Date March 2023

Attested by:

Adviser:
Date: 2023
ACKNOWLEDGEMENT
 ABSTRACT

ANTIBIOTICS OVER THE COUNTER: AN INVESTIGATION ON ANTIBIOTIC

DISPENSATION WITHOUT A PRESCRIPTION OF LOCAL DRUGSTORE

by

Jemimah Chan
Ela Sophia Khu
Sean Ashley Laborte
Keem Bryan A.Pornobi
Jenalyn Rubante
Mary Ann Tesorero
March 2023
 TABLE OF CONTENTS

Page
Title Page………………………………………………………………
Approval Sheet ………………………………………………………..
Certificate of originality ………………………………………………
Acknowledgments………………………………………………………
Abstract…………………………………………………………………
Table Of Contents………………………………………………………
List of Appendices………………………………………………………
CHAPTER
1 The Problem of its Background
Introduction …………………………………………………….
Statement of the Problem………………………………………..
Hypothesis of the study………………………………………….
Significance of the study ……………………………………….
Scope and limitations of the study ……………………………..
Definition of Terms …………………………………………….
2 Review of Related Literature …………………………………..
Maternal and Infant Care in Covid-19 Pandemic………………
Maternal Health Care in the Philippines ………………………
Quality Maternal and Infant Health Service …………………...
Theoretical Framework……………………………………………
Conceptual Framework…………………………………………..
Research Paradigm……………………………………………….
3 Research Methodology
Research Design………………………………………………
Locale Of the Study…………………………………………..
Population Of the Study………………………………………
Research Instrument…………………………………………
Validation and Reliability of the Instrument ……………….
Potential Ethical Considerations ……………………………
 Data Gathering Procedure …………………………………..
Appendices ………………………………………………………………..
Bibliography……………………………………………………………….
Curriculum Vitae…………………………………………………………..
LIST OF APPENDICES
Appendix
A Letter of intent to Conduct Study…………………….

B Assessment Survey Questionnaire ( English ) ……….

Assessment Survey Questionnaire ( Tagalog)………..
C Informed Consent Form ( English )……………………
Informed Consent Form ( Tagalog)…………………..

CHAPTER 1
PROBLEM AND ITS BACKGROUD
INTRODUCTION
Medicinal practices is a common work in the Philippines especially in different
remote areas and one of our culture is to pass down practices from our ancestor and one
common is treating ailments without proper knowledge, causing it to be harmful due to
self-medication. Thus, it cause a great trend in increasing of local drugstore in every
region of the country because of its accessibility for Filipino people who cannot afford to
travel faraway to buy medicine in hospitals and it is much more cheaper in price. The
FDA Circular No. 2014-025 issued the implementation of new rules and regulations on
the licensing of drugstores and similar outlets, which shows the requirements, inspection,
and responsibilities of the certain business. Nevertheless, with this FDA regulation there
are still drugstore that lacks the responsibility of dispensing medicine especially
antibiotics, which is one of the medicine to be most misuse causing a lot of problem in
terms of antibiotic resistance and some health risk factors due to inadequate knowledge
of the certain antibiotic.

According to Henry Selvaraj (2019), the main reason antibiotics are overused is
because they are available even without presenting any prescription over the counter.
Center for Disease Dynamics, Economics & Policy. (2019) reported that over the counter
antibiotics are being sold through online shop that roots misusing of leftover drugs.
Adding, one of the primary cause of misused antibiotic is the passing or sharing of
previous prescription in friends and relatives. Researchers implied that selling antibiotics
should cause legible and new prescriptions to prevent some issues causing infectious
disease and people that should set awareness to the public on antibiotics ill effects. The
study recommendation concludes that excess antibiotics should also be asked for and
returned to the pharmacies.

According to World Health Organization’s (WHO) global report on surveillance

of antimicrobial resistance (2016), non- penicillin-susceptible microbial chains have been
identified. In all WHO regions, awareness of using antibiotics without any prescriptions
has adverse effects and knowledge of safe antibiotic practices and antibiotic resistance is
high, mostly in the urban population and among the university students. Worldwide,
approximately 700,000 people die because of drug-resistant infection and a recent report
estimates that by 2050, 10 million people will die every year due to antimicrobial
resistance (AMR) if there is no action (Ahmad et al., 2022). There is a widespread of
irrational and inappropriate use of antibiotics in the Asian regions and it is a major
contributor of antimicrobial resistance (Singh, 2017). Inappropriate use of antibiotics is
commonly seen for a self-limited viral infection like URTIs (Upper respiratory tract
infections), acute diarrhea ,and also for some bacterial infections including UTIs (Urinary
tract infections) and self-medication in the community is a great contributing factor to
inappropriate consumption of antibiotics (Ahmad et al.,2022)

In Pakistan , 96% of community pharmacies dispense antibiotics without

prescriptions (Saleem et al.,2020). Therefore, community pharmacists are dispensing
antimicrobials even without prescriptions to avoid losing their clients to a neighboring
competitor (Figueiras et al.,2018). In the region of Hazara in Pakistan, antibiotics were
supplied without a prescription, to 90.5% with antibiotics being dispensed in 92.9% and
88.1% is for URTI and UTI. In non-prescription antibiotics, 9.5% of pharmacies declined
to dispense antibiotics without prescription.

The Sub-Saharan African (SSA) countries, non-prescribed dispensing of

antibiotics in community drug retail outlets (CDROs) has been flagged as one of the
contributing factors for the widespread misuse of antibiotics in the community. The
overall pooled proportion of non-prescription antibiotics requests or consultations that
resulted in supply of antibiotics without prescription was 69% (95% CI 58–80). Upper
respiratory tract infections and/or acute diarrhoea were the most frequently presented
case scenarios, and amoxicillin and co-trimoxazole were the most frequently dispensed
antibiotics to treat those symptoms. (Belachew et al., 2021)

The latest PhilCare Wellness Index 2021 reveals that self-medication remains
prevalent among Filipinos (Ciriaco, 2022). Self-medication is a self-care practice defined
as the use of medical products by an individual to treat self-diagnosed symptoms, or as
the unsuitable administration of prescribed medicinal products, including the prolonged
and improper use of antibiotics (Geneva, 2017). Self-medication with antibiotic is
problematic, as it as major contributor to antibiotic resistance (Bartoloni et al., 2019).
Recent meta-analyses have estimated that 38% of the world population engages self-
medication and sharing of antibiotics (Morgan, 2019). However, Self-medication varies
globally, with the highest prevalence in Southeast Asia and Western Pacific region of
WHO (58-64%) (Morgan, 2019). Philippines has a documented history of prevalent
antibiotic misuse including one of the highest rates of antibiotic sharing (Kardas, 2020).
Globally, the Philippines has also had one of the smallest percentages of prescriptions
filled by physicians, with non-medical sources being the most common source of
antibiotics (Kardas, 2020). The reported prevalence of antibiotic self-medication in the
Philippines has ranged from 31% to 66% reporting all prevalence than Southeast Asia
(Lansang et al., 2020).

In the Philippines many Filipinos still rely on advertisements, previous medical

prescriptions, and the opinions of their relatives, families, and friends as the basis for
their self-diagnosis and self-medication. Open access to health information over the
internet also adds to the confidence of Filipinos to self-medicate, as supported by the
findings of the latest PhilCare Wellness Index (Ciriaco, 2020). A review by Radyowijati
et al. (2017) highlighted the deficit in sharing and dispensing antibiotics; it revealed that
the major studies in self-medication with antibiotics have examined antibiotic prescribing
and the purchasing of antibiotics rather than informal antibiotic dispensing within a
community. With the current pharmaceutical laws enforced in the Philippines, the
community find difficulties buying antibiotics (Ramos, 2018). However, over-the counter
antibiotics, such as topical antibiotics, an antibiotic in the form of soap, cream or
treatment, don't require a prescription when purchased (Chua, 2019). Dispensing without
prescriptions is irrational and can hasten the emergence and spread of antibiotic
resistance (Bahta et al., 2019).

Department of Health (DOH) warns public to stop misusing or overusing

antibiotic to prevent Antimicrobial Resistance (AMR). Antimicrobial Resistance (AMR)
is when the microorganism is being expose to any antimicrobial drugs such as antibiotic,
the microorganism can resist medicines. As per Maribel Cruz, Pharmacist III of DoH 5
we can only hope to change people's behavior when it comes to taking antibiotics by
being stringent with prescriptions and organizing more informational caravans. She
added that misusing of antibiotics can leads to low effectiveness of medicines when it
intakes and can cause infection to grow rapidly. One example of AMR is what we called
Multi-drug Resistant TB (MDRTB), this MDRTB can resist atleast four Anti-TB drugs,
as shown by data from the World Health Organization (WHO). According to records
from 2017, 368 persons in Bicol, predominantly men between the ages of 25 and 54,
were diagnosed with MDRTB. DoH personnel warns the public to follow and finish
correct procedures to take medicine, and also they remind pharmacist to sell antibiotic
with prescriptions. Addressing the gap in knowledge the research extends to the
pharmacies’ dispensation of antibiotic for consumer without prescription literature by
using exploratory sequential method.

The aim of the study was to investigate the attitudes, practices, reason/s, and
level of awareness of both the pharmacy and consumer subsequently  establish
meaningful insight regarding antibiotic dispensation without prescription in local
pharmacy.

STATEMENT OF THE PROBLEM

This study was directed towards its main objective of making an investigation
regarding the dispensing of antibiotics without prescription on local drugstore in an
exploratory sequential approach. Specifically, the researchers sought answers to the
following questions:

1. How does the profile of the drug store be described in terms of:

1.1 Certification/Permit to operate

1.2 Number of licensed pharmacist among the employees

2. How does the profile of the consumer can be described in terms of:

2.1 Age

2.2 Gender

2.3 Medical condition

3. What are the attitude/practices of these drugstores when selling/dispensing an
antibiotic drug?

4. What are the possible reason/s why consumer buy antibiotics without prescription?

5. What are the level of awareness of consumers that antibiotic requires prescription?

6. What are the level of awareness of pharmacist and the consumer on the microbial
resistance?

7. Is there a significant difference between the attitude/practices of these drugstores when

selling/dispensing an antibiotic drug and the awareness of consumer of the microbial
resistance?

8. Is there a significant difference between the attitude/practices of these drugstores when

selling/dispensing an antibiotic drug and the awareness of pharmacist of the microbial
resistance?

CHAPTER 2

REVIEW OF RELATED LITERATURE

This chapter presents the related local studies, foreign studies, local literatures,
and foreign literatures. It includes information that are relevant and to give better
understanding to the study.

Foreign Studies

In the study of Belachew et.al (2021), about “Non-prescription dispensing of

antibiotic agents among community drug retail outlets in Sub-Saharan African countries”,
they pointed out that one of the contributing factors of widespread misuse of antibiotics
in their community is because of the drug retail outlets that dispensed antibiotics without
prescription. As of their result, they gathered around 69% overall proportion of non-
prescription antibiotics request or consultation with mostly common cases of the
following medical conditions: Upper respiratory infection and Acute Diarrhea. For most
frequently dispensed antibiotic to treat this symptoms are amoxicillin and co-trimoxazole.
 Likewise, according to the study of Batista et.al (2020) about “Antibiotic
Dispensation without a Prescription Worldwide”, they also believed that one of the
drivers of global health problem of antibacterial resistance is due to dispensing of
antibiotics without a proper prescription in the communities pharmacy worldwide. Their
record worldwide obtains, that low-and middle-income countries practiced this
commonly. Also, the result shows the most sold antibiotics worldwide were amoxicillin
with 86.9%, azithromycin with 39.3%, ciprofloxacin with 39.3%, and amoxicillin-
clavulanic acid with 39.3%. With this antibiotics, it shows association with respiratory
system problems (100.0%), diarrhea (40.0%), and Urinary Tract Infections (30.8%).

On the other hand, Barker et.al (2017) studies the factors that drives inappropriate
dispensing of antibiotics practices of pharmacies in the village of India to better
understand the perspective of the employee. They have recruited 24 community
pharmacy employees along with their profiles and background. Their results shows that
75% of these employees were unlicensed practitioner and majority has least knowledge
and understanding of antibacterial resistance. They also recorded that these practice are
common to those patient who struggled or has limited access to a licensed physician due
to inadequate economic or logistic reason. As for their conclusion they suggested to have
a need of training on antibiotic prescribing and resistance especially in the areas of
limited healthcare access and that they should put an accountability to the people who is
responsible, and to better prevent the antibiotic misuse.

In the study of Farah, R., et.al (2018) concludes that overuse of antibiotics is a
component of the global spread of antimicrobial resistance. Their previous investigations,
mostly in underdeveloped nations, demonstrated an excessive use of antibiotics obtained
through community pharmacies without a prescription. Studies examining the part played
by neighborhood pharmacists in the abuse of antibiotics are scarce. The study found that
both higher and lower lower socioeconomic socioeconomic groups have access to over-
the-counter antibiotics: overall, 32% of antibiotics were given out without a doctor's
prescription  with a higher frequency in lower socioeconomic areas. In lower
socioeconomic areas, it was substantially more common to dispense both an association
of 2 antibiotics and injectable antibiotics without a prescription. Children and the elderly
were given antibiotic prescriptions more frequently by pharmacists working in lower
socioeconomic areas. The research concludes that Community pharmacies in Beirut
frequently dispense antibiotics without a doctor's prescription, especially in areas with
lower socioeconomic status. The social, educational, and legislative spheres should all be
involved in addressing this public health issue.

Connection to that being said in Wemrell, M., et.al (2022) study investigate if
antibiotic use in society has a direct correlation to the growing threat that antimicrobial
resistance poses to global public health. Actions aimed at maximizing the use of
antibiotics should be put into place on a fair basis and in accordance with the needs of the
community. The research found that there is no significant differences in the
dispensation of antibiotics between socio-economic groups, despite the fact that women
and high earners had the highest prevalence of antibiotic dispensation. Instead than
targeting certain demographics, public health initiatives to encourage the optimal and
reduced use of antibiotics should target the entire Swedish population. Consequently,
interventions aiming at enhancing medical practitioners' antibiotic prescribing patterns do
not call for a greater emphasis on socio-economic or demographic characteristics.

Local Studies

In the Philippines, self-medication is a major problem among Filipinos. Estimated

that 38% of world's population engaging self-medication with antibiotics (Morgan,
2019). Radyowijati (2019) highlighted the deficit in antibiotic sharing that the majority of
studies including the dispensing of antibiotics have examined antibiotic prescribing and
dispensing antibiotics without prescription in the community. According to DOH (2017)
dispensing/selling antibiotic without prescription is strictly prohibited. However, the
community tends to share antibiotics in their lifetime because antibiotics are accessible
on drugstores and they can purchase it without a prescription (Ybanez, 2017). Recent
study by Ybanez et. al (2019) point out the correlation of antibiotic sharing in the
Philippines for the antibiotic misconceptions and community level access to non-medical
sources of antibiotics. The antibiotic knowledge of the respondents was moderate. 88% of
the respondents understood that the antibiotic treat infections, however 81-85% of the
respondents believe that antibiotics can treat viral infection, common colds and cough.
On the other hand, 55% did not know that antibiotics could have side effects and 70% did
not understand the potential of developing antibiotic resistance from improper antibiotic
use. 65% indicated that they find difficult to purchase antibiotic even without
prescription, 55% agreed that it was easy to access antibiotics without prescription. Some
of the respondents believe on some misconceptions and misuses of antibiotics like taking
a small doses and putting crushed antibiotics into wounds. Lastly, a sizeable proportion
agreed that a regular administration of antibiotics could prevent HIV. The study findings
demonstrate that misconceptions were more strongly associated with antibiotic sharing
and the accessibility of antibiotics in the community. The study shows that majority of
the people in the community engaging antibiotic misuse and misconceptions in their self-
medication

On a qualitative study on the design and implementation of the National Action

Plan on Antimicrobial resistance (AMR) in the Philippines (2022) stated that in order
improve the Infection, presentation and control (IPC) is the establishment of Infection
control committee (ICC) which was composed of management staff, pharmacists,
physicians and other health care workers to aware people for the antimicrobial resistance.
Also, to guide community on the recent policies, guidelines and procedures to avoid
microbial infection. In this way, the community can prevent unwanted infection of
bacteria and they're not going to self-medicate with prescribe antibiotics that may lead to
AMR.

Foreign Literature

In a study conducted by Jaffar, A. and Hisham, M (2020), . Health-care systems

are under stress, and mortality and morbidity go up. By encouraging antibiotic
stewardship and supporting the development of new drugs, healthcare workers may
combat the growing AMR. It is comforting to know that new agents are still being
created in spite of the scientific and economic obstacles. New antibiotics that are in
development are covered in this overview. We looked up approved and upcoming
antibiotics in phase 3 or new medication applications in the literature using Medline,
Clinicaltrials.org, and pertinent pharmaceutical companies (NDA). They discovered a
number of novel antibiotics and evaluated their stage of development, mechanism of
action, range of activity, and approved uses. The phase 3 clinical trials included studies
were mostly used for the treatment of acute bacterial skin and skin structure infections,
community-acquired bacterial pneumonia, and pneumonia contracted in healthcare
settings. These agents only affect a small number of high priority organisms. The
discovered antibiotics were primarily based on known compounds or already existing
antibacterial substances. They concluded that Antibiotics that are effective against high
priority microorganisms including carbapenem-resistant Enterobacteriaceae and multi-
drug resistant Pseudomonas aeruginosa are few. There is an urgent need for new
antimicrobial medicines targeted at the highest priority species as listed by the World
Health Organization

According to Stig Wall (2019), In the previous 70 years, there has been a dramatic
improvement in world health, and antibiotics have become the mainstay for the treatment
of infectious diseases. Antibiotic resistance is ranked by the World Health Organization
as a "global security issue" that is as significant as terrorism and climate change and has
an influence on global health, food security, and development. This research examines,
through a scoping analysis of the literature produced in the last 20 years, the volume of
peer-reviewed and Grey literature that addresses antibiotic resistance, in particular, the
degree to which "prevention" has been at the center. Finding know-do gaps and ABR
prevention techniques is the ultimate goal. The review includes searches from 2000 to
2017 in four major databases: Web of Science, Medline, Scopus, and Ebsco. Antibiotic
OR antimicrobial resistance was a more general search term that produced 431,335 hits.
There were 1062 titles left after limiting the search to "Prevention of antibiotic OR
antimicrobial resistance." 622 of these had unique titles. Following a relevancy check on
the 622 titles, 420 abstracts were read, and of these, 282 full papers were read. From
these publications, 53 more references were found, and 64 works from 2018 and 2019
were also included. 399 publications made up the final scoping review database as a
result. When categorizing articles in various subject areas, a thematic framework
developed that acted as a stand-in for the research community's professed interest. About
half of the 399 papers that were published during the course of the study's four-year span
show how the research field is still developing. Particularly in lower- and middle-income
countries, epidemiological modeling needs to be strengthened and there is a need for
additional and better surveillance systems. The local, national, and international uses and
abuses of antibiotics are extensively documented. Programs for education and
stewardship essentially lack proof. Numerous research talk about what the general public
and doctors know. Numerous ominous assessments from domestic and international
agencies express the lessons for policy. The literature has tended to have descriptive
goals rather than theoretical ones. The necessary methods are not being used if we wish
to comprehend and explain the antibiotic issue better from a behavioral standpoint. We
provide a paradigm for an epidemiological causal chain that underlies ABR and might be
used to pinpoint potential entry points for interventions.

Hansen, R. and Francisco J.( 2020),Over-the-counter (OTC) medications are

considered to be safe medications opposite to the prescribed and illegal medications, but
misuse is increasingly being observed (Cooper, 2013).One of the agencies, particularly in
Finland, who is assigned in the monitor misuse and regulate OTC medications in the
market is Fimea.The functions of Fimea are improving the health of the people by
controlling medicinal, tissue and blood products and improving the pharmaceutical
factors (Levanen and Gurung, 2011). It is the Fimea’s aim to be improve the people of
Finland’s pharmaceutical service, enhance the safety, appropriateness and economy of
the distribution of medicines.During of the 2000s, the consumption of OTC medications
went up by nearly 50% while wholesale reached up to estimated 155 million euros and
for approximately 228 million euros in 2013 (Fimea, 2015). According to national
statistics it made by Fimea in 2013, 50% of consumers had used OTC medications
during the week, and one out of ten Finnish adult uses them every day.at this point, they
let people Finnish the OTC medications are usually designated in the self-service area
like pharmacies, where a pharmacist is ready for counselling.it is allowed to buy OTC
medication from a cashier without the counsel of a pharmacist in the event of urgency
like rush hours or if a consumer hesitated to ask pharmaceutical advise (Ylä-Rautio,
Siissalo & Leikola, 2020).Self-medication is where the treatment of common health
issues with medicines which are intended for use with non-prescription of health
professionals and authorized as safe and effective. Self medication is a vital part of self-
care that is important in a generation of growing chronic diseases and well-informed
health care clients (International Council of Nurses or ICN and World Self Medication
Industry or WSMI, 2012).the threats regarding OTC medications are often being
overlooked by patients, and the improper use of some medications can result in patient in
danger (Ylä-Rautio, Siissalo & Leikola 2020). the researchers will be using the word
“misuse” when referring to the improper use of OTC medications.This study will address
only the promotion of OTC medication’s safe use in the healthcare system. Over-the-
counter medicines (OTC) can be considered as harmful as prescribed medications if not
properly consumed.the safe use of OTC medications is essential (Consumer health care
products association, 2010).This is the capability of encouraging everyone to have good
health, avoid diseases, and to adjust with conditions with or without the consultation from
a medical professional (WHO, 2020). While Fimea (2018) stated that in accordance with
the Finnish pharmaceutical policy, self-care should always be a priority in health care.

The World health Organizations (2019), in dispensing and prescribing of

antibiotics.It was reported that a prescription is required to obtain antibiotics from a
pharmacy in all countries and areas. There two thirds of respondents (11/17; 65%)
suggested that these regulations are enforced, but respondents from six indicated that
pharmacists “regularly” sell OTC antibiotics without prescription, and respondents from
a further eight said this occurred “occasionally”. Respondents indicated these OTC sales
included oral agents (14 countries and areas) and injection formulations , along with
topical, eye and ear drop antibiotic formulations . there was Eleven reported other ways
that patients can obtain antibiotics apart from with a prescription from a doctor.Most of
the systems also allowed reporting of concerns about quality of antibiotic products, but
the extent to which such reporting mechanisms are used varies enormously; in some, it
seems that the systems exist but are not used to any meaningful extent.

Local Literature

According Research Institute for Tropical Medicine (2017), Antimicrobial

resistance (AMR) is a major public health concern. AMR develops when antimicrobial
are misused and overused, and it can spread and can transfer to humans directly via direct
contact to resistant organisms through ingestion of the products or through environmental
runoff exposures. Resistance can pass on from one person to another and spread beyond
local borders, especially if proper infection control is not practiced. The spread of
resistant organisms can strain and challenge the already dwindling antimicrobial options
available. This can lead to what experts have termed as “post-antibiotic era” wherein
even minor infections may lead to death. Medical management and surgeries will be
difficult to perform because of possible infection during and after the procedures.

As mentioned by Cruz of the Department of Health (2018), misusing antibiotics

would render medicines and let infections in the body, which can increase the risk of
spreading the disease to others. She also added that AMR also threatens the effective
prevention and treatment of an ever-increasing range of infections caused by bacteria,
parasites and fungi. Records from 2017 registered a total of 368 people in Bicol afflicted
with MDRTB, mostly males aged 25 to 54.Cruz advised the public to consult a doctor
before taking antibiotics, follow and finish the correct regimen when taking medicines,
and desist from giving excess antibiotics to others.When coughing or sneezing, cover the
mouth to prevent bacteria from spreading, she added. Cruz also reminded the public that
drugstores have been told not to dispense antibiotics without prescriptions. To strengthen
their thrust of preventing AMR, DOH conducts lectures as part of most of its programs
and observes the Philippine Antibiotic Awareness Week in November of each year.