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
 OUR LADY OF FATIMA UNIVERSITY

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 TesoreroIn 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

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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
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ACKNOWLEDGEMENT
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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
 OUR LADY OF FATIMA UNIVERSITY

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 ………………………

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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)…………………..

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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
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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
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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)
 OUR LADY OF FATIMA UNIVERSITY

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.