Chapter 1

The Problem and Its Background

This chapter provides a broad overview of the research reported in this thesis and it introduces

the research strategy of the thesis. The chapter begins with a discussion on the background and

motivation of this research. And introduces the knowledge on how people taking antibiotics are

unproportioned.

Introduction

Antimicrobial resistance was identified by The Lancet Microbe1 as a serious but frequently

disregarded hazard to public health. The international community must act quickly in response to

global disparities in access to antibiotics, a lack of data from low-income and middle-income

countries (LMICs), where antibiotic resistance is 21 an impending crisis, and a lack of antibiotic

stewardship in the majority of resource-constrained tertiary care facilities. Cultural misunderstandings

and insufficient regulation and enforcement of antibiotic usage have affected physician and patient

attitudes and behaviour in the Philippines, a lower-middle income nation in Southeast Asia.

With a frequency of 31-66%, self-medication is widespread in the Philippines.3 Self-

medication offers some semblance of health care, especially for low-income households that minimize

opportunity and financial expenditures (ie, productive work hours compromised by long clinic wait

times) In citation of Umair, Muhammad et al. The Lancet Microbe, Volume 0, Issue 0

Our capacity to cure common diseases is still under danger due to the creation and spread of

bacteria that are resistant to drugs and have developed novel resistance mechanisms. The increasing

global development of multi- and pan-resistant bacteria, commonly referred to as "superbugs," which

cause diseases that cannot be treated with current antimicrobial medications like antibiotics, is

particularly concerning.
 Patients may receive less-than-optimal doses of antibiotic medication if their antibiotic

therapy is misused, including failure to finish the course of treatment, dose skipping, or reuse of

leftover medicines. Such antibiotic use may lead to inadequate antibiotic exposure for the eradication

of pathogenic germs and may result in the development of an environment that encourages antibiotic

resistance. Antibiotic resistance, treatment failure, length of hospital stay, pharmaceutical waste, and

additional doctor visits are all effects of improper use of antibiotic therapy.

When individuals start to feel better or when negative side effects start to appear, patients

typically report stopping their antibiotic therapy. In a significant community study on antibiotic

compliance, patients in nine countries stated that 10–47% of patients did not complete a course of

antibiotic therapy and that 4–41% saved leftover drugs for later.

When drug resistance increases, antibiotic effectiveness declines.

What causes antimicrobial resistance to arise and spread more quickly?

AMR develops throughout time, typically as a result of genetic alterations. The environment, humans,

animals, food, plants, and the environment all include antimicrobial resistant microbes (in water, soil

and air). They can transmit from person to person, through humans and animals, or even via animal

products in food. The misuse and overuse of antibiotics, a lack of access to clean water, sanitation,

and hygiene (WASH) for humans and animals, inadequate infection and disease prevention and

control in hospitals and farms, a lack of access to high-quality, reasonably priced medications,

vaccines, and diagnostics, a lack of awareness and knowledge, and a lack of legal enforcement are the

main causes of antimicrobial resistance.

An international danger to development and health is antimicrobial resistance (AMR). To

attain the Sustainable Development Goals, urgent multisectoral action is needed (SDGs).
One of the top 10 worldwide public health hazards to humanity, the World Health Organization

(WHO), is AMR.

Drug-resistant infections are mostly brought on by the improper use and abuse of antibiotics.

The proliferation of bacteria, some of which may be resistant to antibiotic therapy, is encouraged by a

lack of clean water, proper sanitation, and effective infection prevention and control.

The economic burden of AMR is substantial. Long-term disease not only increases the risk of

mortality and incapacity but also lengthens hospital stays, necessitates the use of more expensive

medications, and puts a strain on the finances of those affected.

Effective antimicrobials are essential to the development of contemporary in citation

This research, to my knowledge, is the first of its type to look at correlates of

The first study to look at the antibiotic diversion in Southeast Asia or the Philippines

antibiotics in sari-sari stores: availability and state. This study's objective was to determine the

sociodemographic, intellectual, and behavioural traits that antibiotics in the Philippines and to look at

data at the neighbourhood level on unofficial routes for distributing antibiotics. Importantly, the

majority of responders (78%) claimed to have shared antibiotics throughout their lives. The sari-sari

retailers' data showed that antibitics In the communities surveyed, were easily accessible without a

prescription 60% of the time. Moreover, purchasing a complete course of antibiotics was uncommon

(68%), and Expiration dates were frequently obscured or missing (59%). Overall, the research

located both Samples were sequenced from more than 20 sites across the Philippines, focusing on

bacteria that are resistant to the last-line antibiotics, and listed by the World Health Organization as

top priority pathogens for the development of new antibiotics**. The teams collectively analyzed the

data, creating phylogenetic trees that showed how the bacterial strains are related to each other, and

uncovered several high-risk clones.

Combining the genetic findings with epidemiological data allowed the researchers to pinpoint strains

in particular locations. In one hospital they identified a cluster of the same strain of carbapenem-

resistant Klebsiella pneumoniae in a neonatal intensive care unit, and revealed that this was being
spread within the hospital. This evidence enabled the hospital to bolster their infection control team,

to control potential future outbreaks.

Dr Celia Carlos, joint lead of the project from the Research Institute for Tropical Medicine,

Philippines, said: “Here in the Philippines we have more than 30 years of experience developing

laboratory methods to track AMR, with our Antimicrobial Resistance Surveillance Program. Now,

working with our partners in the UK, we have established local capacity and expertise for whole

genome sequencing in the Philippines, adding genomic surveillance to these other methods. This is

helping us to identify emerging resistant strains much faster, so we can understand what is happening,

prevent transmission of AMR and save lives.”

Dr Silvia Argimón, first author on the paper from the CGPS said: “The programmed not only helped

set up the genomic infrastructure in the Philippines, but also enabled close collaboration between the

teams in the UK and the Philippines. This included exchange visits between the researchers and

training to transfer ownership of the sequencing, analysis and understanding to the team in the

Philippines, and ensured that everyone understood the resourcefulness and challenges of the sentinel

sites.”

Genomic surveillance allows the team to describe drug-resistant bacteria in terms of their strains,

which genes enable the resistance, and how those genes are transferred between bacteria. Through

genomics the Philippines now have a greater lens on AMR at the local, the national and international

scale, allowing data analysis l2 at a previously difficult level. The data are shared with Philippine

public health agencies and with the WHO to inform both local and global understanding of the spread

of carbapenam resistance.

To cite of Professor David Aanensen, Director of the CGPS and joint lead on the project,

said: “Understanding national dynamics in antimicrobial resistance is important in every country in

the world to prevent spread globally, and new technology and tools that enhance this capacity are

required. The work by the Philippines team to establish

genomics within a national surveillance network is an exemplar for adoption that could be extended to

tackle the global challenge of antimicrobial resistance or other infections.

 Bacteria is a unicellular microorganism that plays an extensive role in the world, being one of the

most important decomposers to posing some of the most lethal threats to humanity. While only a

small portion of bacteria is considered a deadly pathogen, bacterial infection poses a considerable

influence in public health. (Doron, S et al, 2008)

Earliest discoveries of antibiotics date back to 1928 after Alexander Fleming found Penicillin,

extracted from the Penicillium mold. (Ventola C, 2015) Penicillin has been established to counter

several forms of gram positive cocci, rods, anaerobs, such as Salmonella and E coli, typically causes

of diarrhea. (Yip D, 2022) Due to the wide range of uses of Penicillin, it became mass produced in the

1940s further exposing to non related infections which brought the earliest recorded penicillin

resistance. (Sengupta S et al, 2013) Antibiotics are developed to kill infection causing bacteria on a

patient’s body, thereby increasing his survivability dramatically. If used and administered correctly,

this type of drugs are shown to increase the life expectancy of people due to their ability of addressing

bacterial infection. (Rosollini G, 2014) As stated by (Cesur, S, nd), resistance is a bacteria’s capability

to counter the effects of bactericidal. Antibiotic resistance as detailed further by their paper, is caused

by either natural causes by virtue of their physiological characteristics or acquired, the mutation that is

caused by the extensive and oftentimes incorrect use of antibiotics.

Since 1945, the proponent of Penicillin raised the problem on the overuse of antibiotics. (Spellberg B,

2014). The centre of disease control of the United States illustrated how overuse will most likely drive

resistance. The study of (Gross M, 2013) has shown that in some states of the US, the amount of total

prescription is more than the total population, effectively telling that each person took more than a

single dose of the medication. Its availability over the counter or sometimes the local grocery stores in

the Philippines play a role in the excessive use of antibiotics.

Inappropriate prescribing is also one of the causes of resistance. The research conducted by (Luyt C,

2014) has shown that antibiotic prescriptions are incorrect for 30% to 50% of the time. Wrong usage,

duration of course of treatment, and choice of agent all contribute to the likelihood of genetic

alterations of a bacteria which will then render the given treatment obsolete for future use.
 While the problem in antibiotic resistance is mostly discovered on the developed countries

due to their advancement in technology, poorer nations are left behind. The emergence of its threat,

however, cannot be denied and may actually be more aggressive on the developing countries due to

their lack of access to free and quality healthcare. Because of the bacteria’s ability to adapt and

diminish, and in some cases, completely negate the effect of an antibiotic, medication for the patients

that developed resistance is more complicated and costly. (Jee Y, 2018) The cause and effect of this is

therefore magnified on the poorer and marginalised populations. According to the research of (Allel K

et al, 2017), poverty and material deprivation are key factors for the development of antibiotic

resistance.

Since adherence to correct use of the medication is adamant, those that hardly make ends

meet will most likely suffer. A household with no income will presumably shorten the duration of

taking a pricey medication. Coupled with the lack of awareness, those living on the margins of society

will most likely take amoxicillin bought on a grocery store for a skin infection without proper

prescription from a healthcare professional. Limay Bataan, being a mostly rural population with little

to no access to quality healthcare will be more susceptible to the effects of resistance.

In this study, the researchers will attempt to bridge and connect the gap and study the

gruelling effect and relationship of the socioeconomic status of the various communities in Limay to

their adherence to proper usage of antibiotics thus directly affecting their likelihood to develop

antimicrobial resistance

In this study researchers showed on how antibiotic Resistances affects to the of community of

Lamao Limay, Bataan many people doesn’t know how to take Antibiotics properly it concerns that

Antibiotic Resistances leads to longer hospital stays, higher medical costs increased mortality.

Furthermore many people in Lamao doesn’t have enough to take a high quality medicine thus of the

high inflation rate

 The overall goal is to ensure, for as long as possible, continuity of the ability to treat and

prevent infectious diseases with effective and safe medicines that are quality-assured, used in a

responsible way, and accessible to all who need them.

Statement of the Problem

“A Study on the repercussion of the Misuse of Antibiotics to the Emergence of Antibiotic

Resistance in Barangay Lamao’’

The researchers sought to answer to the following specific questions:

1.What are the reasons behind antibiotic misuse?

2. How are people affected by antibiotic resistance?

3. How will the repercussion of the misuse of Antibiotics effect your health?

4. What are the danger of misuse of Antibiotics?

Scope and Delimitation

The general intent of this study is to investigate the repercussion of the misuse of antibiotics

to the emergence of antibiotic resistance in Barangay Lamao with the focus on patient health after

taking antibiotics. Also this study is to know the causes of antibiotics resistance to a certain person.

The study limits its coverage on the patient in Lamao who used antibiotics only.

𝐒𝐈𝐆𝐍𝐈𝐅𝐈𝐂𝐀𝐍𝐂𝐄 𝐎𝐅 𝐓𝐇𝐄 𝐒𝐓𝐔𝐃𝐘

𝙊𝙏𝙃𝙀𝙍 𝘾𝙊𝙈𝙈𝙐𝙉𝙄𝙏𝙔

Antibiotics provide effective treatment for a wide variety of infections and illnesses.

Unfortunately, antibiotic resistance makes these things more difficult to treat. It also strains the

healthcare system due to increased hospital stays and expensive treatments. Many people are at risk,

especially those in long-term care facilities or who have weakened immune systems.

𝘿𝙊𝘾𝙏𝙊𝙍𝙎

Doctors have a leading role in antimicrobial stewardship, educating patients about

antimicrobial resistance, and improving prescription practices to save antibiotics for the future

generations.

𝙁𝙐𝙏𝙐𝙍𝙀 𝙍𝙀𝙎𝙀𝘼𝙍𝘾𝙃𝙀𝙍

People will be sicker for longer, people will have fewer options to get better, and the cost of

care will increase. In the future, more people may also die from secondary bacterial infections that are

resistant to antibiotics.

Notes in Chapter 1s

Allel K, Garcia P, Labarca J, Munita M, et al. Socioeconomic factors associated with antimicrobial

resistance of Pseudomonas aeruginosa, Staphylococcus aureus, and Escheichia coli in Chilean

Hospitals. 2018. Retrieved from

https://iris.paho.org/bitstream/handle/10665.2/52265/v44e302020.pdf?sequence=1&isAllowed=y

Cesur S, Demiroz A nd. Antibiotics and the Mechanisms of Resistance to Antibiotics. Retrieved from

https://jag.journalagent.com/ias/pdfs/IAS_21_4_138_142.pdf.

Doron S, Gorbach S. 2008. Bacterial Infections: Overview. Elsevier Public Health Emergency

Collection. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7149789/

Gross M. Antibiotics in crisis. Curr Biol. 2013;23;R1063-R1065

Jee Y, Carlson J, Rafai E, Musonda K, Huong TTG, Daza P, et al. Antimicrobial resistance: a threat to

global health. Lancet Infect Dis. 2018;18(9);939-40

Luyt CE, Brechot N, Trouillet JL, Chastre J. Antibiotics stewardship in the intensive care unit. Crit

Care. 2014;18:480

Rosollini GM, Arena F, Pecile P, Pollini S. Update on the antibiotic resistance crisis. Clin Opin

Pharmacol. 2014;18:56-60.

Sengupta S, Chattopadhyay MK, Grossart HP. The multifacted roles of antibiotics and antibiotic

resistance in nature. Fron Microbiol. 2013;4;47.

Spellberg B, Gilbert DN. The future of antibiotics and resistance: a tribute to a career of leadership by

John Bartlett. Clin Infect Dis. 2014;59:S71-S75

Ventola, C. 2015. The Antibiotic Resistance Crisis. Retrieved from

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4378521/#b18-ptj4004277
Yip, D. Gerriets, V. 2022. Penicillin. Retrieved from

https://www.ncbi.nlm.nih.gov/books/NBK554560/

https://www.google.com/amp/s/www.healthdirect.gov.au/amp/article/bacterial-infections

https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance

https://pidsphil.org/pdf/2016/16LEC-09-Philippine-Action-Plan-to-Combat-Antibiotic-Resistance-

Celia-Carlos.pdf
 CHAPTER TWO

THEORETICAL FRAMEWORK

This chapter provides an overview of previous research on knowledge sharing and intranets.

It introduces the framework for the case study that comprises the main focus of the research described

in this thesis.

Relevant Theory

The emergence of multiple-drug resistant pathogens in patients who are seriously ill

represents a new challenge for the critical care physician. In the therapy of pneumonia and sepsis,

initial empiric therapy may be ineffective if the responsible pathogen is not susceptible to available

therapy. This is becoming a reality for certain strains of P. aeruginosa, Acinetobacter spp., and

Stenotrophomonas maltophilia, among enteric gram-negative bacteria; and an ongoing problem

among gram-positive bacteria such as S. aureus and enterococcus. The factors predisposing to

resistance are numerous, but previous investigations have shown that both nosocomial pneumonia and

bacteremia caused by resistant gram-negative bacteria can be a consequence of prior antibiotic usage.

The clinical impact of resistant bacteria is not fully known, but the “attributable mortality” of

pneumonia caused by these organisms appears to be increased, compared with pneumonia resulting

from more easily treated bacteria in the same types of patients.

With the rise in antimicrobial resistance have come a variety of strategies designed to prevent

this problem. In a recent consensus conference, the Centers for Disease Control suggested that the

problem could be better controlled through optimization of prophylactic, empiric, and therapeutic

antimicrobial use and that this could be accomplished by education about appropriate antibiotic use

and by providing data to physicians about the types of resistant organisms seen in their own intensive

care units as part of an ongoing surveillance program. If such a program is to be successful, it may be
necessary to use predefined guidelines to dictate which antimicrobials should be used for empiric

therapy. In one such program, a computer-driven antibiotic guideline was applied for more than 5 yr

and was able to reduce antibiotic costs, increase the appropriateness of prophylactic therapy, and

minimize adverse drug reactions, without leading to an increase in antibiotic resistance.

The advent of guidelines for the therapy of infection is not without concern, and some have

suggested that the use of widespread, broad-spectrum empiric therapy will only add to the resistance

problem. However, it is theoretically possible that if empiric therapy is given in a timely manner,

using highly effective agents, it could lead to rapid bacterial killing and thereby minimize the

emergence of resistance, an event that often occurs when therapy involves an agent with “borderline”

activity against the target organism. In this issue of the journal, Kollef and colleagues have

demonstrated that a scheduled change in defining which antibiotic should be routinely used for

nosocomial infections in a cardiac surgical ICU led to a reduced incidence of pneumonia and

bacteremia because of resistant organisms.

Related Literature

To identify the key indicators which will most likely result into occurrence of AMR in the

Philippine setting, it is worth looking into the following variables:

AMR likelihood, which will be defined as the risk of development of antimicrobial resistance in a

community. Illness Management which will be defined as factor by which a specific illness, when

encountered by a patient, is being managed. Antibiotic Usage which refers to the use of antimicrobial

products, if the patient has been adhering to prescribed practices. Medical Access to assess whether

the patient is able to visit a doctor or at least a health professional. Healthcare Availability to measure

the availability of accessible and affordable healthcare within the community, assessment of drug

prices, etc.
 Antibiotic resistance / Antimicrobial resistance (AMR) as detailed by (Irfan, et al., 2022), is a

challenge posed by microorganisms, typically bacteria, that are resistant to drugs established to have

previously control them. The World Health Organization emphasized that a growing number of

bacteria developing resistance is most concerning. This phenomenon will tremendously affect the

healthcare systems to cure common diseases. Patients infected by pathogens which carries this gene

mutation will most likely cause a more complicated and, in some cases, more severe infections and

diseases which traditional medicines would not fight off. Coupled with the complexity as to how the

different numerous factors lead to AMR, it would rather be more difficult to suppress it. Indicators of

resistance can be seen across different fields, not limited to the medical setting, such as veterinary and

agricultural sectors (Holmes, 2016). Due to the constraints of limited resources, the researchers seek

to rather examine the factors of misuse and its different effect with the aim to bridge the relationship

of resistance to socioeconomic factors.

AMR as cited by the WHO, are most commonly reported to be present on various sources,

humans, livestock, and the environment to which they are mostly thriving. Overgrowing population

mainly drives AMR organisms — from the problem of resource limitation which forces farmers and

hog growers to excessively use antibiotics to treat their livestock, to the problem on sewage, manure

disposal, manufacturing wastes, and hospital products disposal — which (Trotter, et al., 2019)

attributes a record 10 million fatalities by 2050.

The advancement in science has helped find numerous antibiotic classes, some of which are

derived from a family of fungi thereby reducing the problem of infectious diseases. However, the

growth of organisms showing resistance, whether full or partial, to this compounds once again is

challenging public healthcare. Study of (Davies J et al., 2010) demonstrated the development of these

organisms within a short period of time. For instance, within a year of approval of the drug

amisoglycoside streptomycin by the US FDA to treat TB infection, resistance has been recorded on

some patients. The increase in Enterobacteriaceae, a family of gram negative bacteria, which are the
leading causes of some of the most common illnesses like diarrhoea have now been found to be

resistant to carbapenems and colistin (Savin, et al., 2020).

A patient suffering from an infection caused by an AMR organisms typically suffer more

severe symptoms due to its continuously increasing number inside the body, something that would

have been controlled by antimicrobials. The Center for Disease Control and Prevention detailed the

existence of multi-drug resistant tuberculosis-causing bacteria strain has left those that are affected by

the ailment more susceptible to the symptoms because it has rendered the drugs isoniazid and

rifampin obsolete. Due to this, patients are left with less potent treatments. The CDC also highlighted

the possibility of a community transmission of the said strain — another yet alarming situation which

highlights the need to further study its drivers.

While most documented cases of AMRs has been reported on the developed countries

showing its extensive scope, poorer countries are being left behind from surveillance of cases denying

the gravity of its extent to rendering them incapable of treating its cause and developing proper

mitigation measures. One can only imagine how a first world country are troubled by this problem,

the very same issue which may have been circulating and causing an even bigger casualty to the less

developed ones. (Klein et al., 2018) estimated that for the 76 countries that are top consumers of

antibiotics, consumption of the drug has increased by around 39% between 2000 and 2015. The

uptrend is mainly due to the increase in the consumption of low to middle income countries. This

number just shows the growing susceptibility of poorer communities.

Socio economic factors leading to this phenomenon is commonly overlooked (Allel K, et al.,

2020) has shown on their paper that aside from the lack of adequate sanitation systems, water

treatment facilities, and waste management, the lack of awareness of people also drives the surge of

AMRs. The World Health Organization further detailed that the lack of data for the poorer regions

such as the Southeast Asia to which the Philippines belong to, contributes to an even more challenge

to control the increasing number of antimicrobial resistant organisms.

 Studies show that poverty and lack of access to quality healthcare are key determinants for the

emergence of antibiotic resistance (Alividza V, 2018). Possible factors that contribute directly to this

is the people’s miseducated habits whenever dealing with antibiotic consumption, whether it be due to

the willful disregard to proper duration or course of treatment to the use of antibiotics in an attempt to

self treat a totally unrelated causes. Adding to these factors is the possibility of lack of access to

quality antimicrobials in the poorer countries compared to the richer ones. Weather condition also

play a role in the diminishing of potency of drugs, a factor that may be easily addressed if for not the

limited resources. The lack of supervision, and poor storage conditions can also drastically affect the

quality of the drugs as detailed by (Ilic K, et al., 2012).

The paper of (Alividza V, 2018) also found significant differences in the level of

antimicrobial resistance across various countries. This development on AMR is characterized by poor

regulation, self-medication, insufficient control of infection within communities classified to as high-

risk, misuse, and inefficient and low quality antimicrobials (Okeke et al., 1999).

As established by countless publications, the people who are living in a low-income

household and communities are most likely to self-medicate which favors antimicrobial resistance.

While in developed countries, main cause of this is overusage, poorer countries exhibit its contrary.

Those living in poverty demonstrates an increased likelihood to shorten the course of medication due

to soaring prices of antibiotics. For some of the common infections, antibiotic prices typically ranges

from Php 20 to Php 80 a piece. Hence, usual prescribed duration of at least 7 days translates to an

average of Php 1,000 — an amount that most Filipinos living off of minimum wage simply cannot

afford.

Furthermore, there has been an increasing incidence of willful negligence on the proper usage

such as those using it for cosmetic purposes without proper prescription from a medical or healthcare
professional. In 2015, a trend among millennials in the Philippines arise which involves the use of

store-bought amoxicillin in combination with other over the counter cosmetic products directly

mixing the substances and using it as a form of face cleansing agent, yet again another alarming

indication that AMR organisms thrive within the uneducated population. In addition, cases of those

taking antibiotics to treat non bacterial conditions such as common colds directly impacts the severity

of the problem. Prescribing antibiotic to cut cost on medications of other diseases adds to the risk of

AMR. (Jama K, 2022) also illustrated that 38% among the 568 Ethiopian participants were

inappropriately using antimicrobial drugs.

The problem on the lack of access to quality and affordable healthcare in the Philippines is

also indicated by the inability of the Filipino people to visit a doctor, dental access, immunizations,

diagnostic testing, among others — all of which contributes to further likelihood of AMR

development. Without access to these services, people tend to adhere to their incorrect practices

leading to their susceptibility.

Poverty as the main driving point to misuse of antibiotics is not the sole factor of resistance. It

is also worth noting how the people’s disregard due primarily of misguided habits and practices on the

usage of these drugs can result to the apparent and subsequent increase in the likelihood of

antimicrobial resistance.

Related Studies

This study is the theory of misuse of antibiotics. Usually the reason for people who take

antibiotics is that they are too complacent that they are completely fine, so they immediately stop

taking it even if the day of drinking prescribed by the doctor is not over. But they are unaware that

taking antibiotics should not be done lazily because it has side effects that may not be seen physically

but recovers from the body of the person who uses antibiotics in a wrong way. One of the challenges

of misusing antibiotics is that the next time you take it, they will no longer work in your body. They
endure not to take antibiotics on time, sometimes maybe because of laziness, but most of the them

also have a hard time buying this medicine because apart from the need for a doctor's prescription,

most don’t have any to buy.

The Antibiotic Resistance Crisis (C. Lee Ventola, et al. April 2015) The rapid emergence

of resistant bacteria is occurring worldwide, endangering the efficacy of antibiotics, which have

transformed medicine and saved millions of lives. Many decades after the first patients were treated

with antibiotics, bacterial infections have again become a threat. The antibiotic resistance crisis has

been attributed to the overuse and misuse of these medications, as well as a lack of new drug

development by the pharmaceutical industry due to reduced economic incentives and challenging

regulatory requirements. The Centers for Disease Control and Prevention (CDC) has classified a

number of bacteria as presenting urgent, serious, and concerning threats, many of which are already

responsible for placing a substantial clinical and financial burden on the U.S. health care system,

patients, and their families. Coordinated efforts to implement new policies, renew research efforts,

and pursue steps to manage the crisis are greatly needed.

Unfortunately, resistance has eventually been seen to nearly all antibiotics that have been

developed. Vancomycin was introduced into clinical practice in 1972 for the treatment of methicillin

resistance in both S. aureus and coagulase-negative staphylococci.It had been so difficult to induce

vancomycin resistance that it was believed unlikely to occur in a clinical setting. However, cases of

vancomycin resistance were reported in coagulase-negative staphylococci in 1979 and 1983.4 From

the late 1960s through the early 1980s, the pharmaceutical industry introduced many new antibiotics

to solve the resistance problem, but after that the antibiotic pipeline began to dry up and fewer new

drugs were introduced. As a result, in 2015, many decades after the first patients were treated with

antibiotics, bacterial infections have again become a threat.

 Antibiotics have not only saved patients’ lives, they have played a pivotal role in achieving

major advances in medicine and surgery. They have successfully prevented or treated infections that

can occur in patients who are receiving chemotherapy treatments; who have chronic diseases such as

diabetes, end-stage renal disease, or rheumatoid arthritis; or who have had complex surgeries such as

organ transplants, joint replacements, or cardiac surgery.

The Danger of Antibiotic Overuse

(en español:El peligro de abusar de los antibióticos)

Antibiotic overuse is when antibiotics are used when they’re not needed. Antibiotics are one

of the great advances in medicine. But overprescribing them has led to resistant bacteria (bacteria that

are harder to treat). Some germs that were once very responsive to antibiotics have become more and

more resistant. This can cause more serious infections, such as pneumococcal infections (pneumonia,

ear infections, sinus infections, and meningitis), skin infections, and tuberculosis.

Two major types of germs can make people sick: bacteria and viruses. They can cause

diseases with similar symptoms, but they multiply and spread illness differentlyBacteria are living

organisms existing as single cells. Bacteria are everywhere and most don’t cause any harm, and in

some cases are beneficial. But some bacteria are harmful and cause illness by invading the body,

multiplying, and interfering with normal body processes.

Antibiotics work against bacteria because they kill these living organisms by stopping their

growth and reproduction. Viruses, on the other hand, are not alive. Viruses grow and reproduce only

after they’ve invaded other living cells. The body’s immune system can fight off some viruses before

they cause illness, but others (like colds) must simply run their course. Antibiotics do not work

against viruses.
 Taking antibiotics for colds and other viral illnesses doesn’t work — and it can create bacteria

that are harder to kill. Taking antibiotics too often or for the wrong reasons can change bacteria so

much that antibiotics don’t work against them. This is called bacterial resistance or antibiotic

resistance. Some bacteria are now resistant to even the most powerful antibiotics available.

Antibiotic resistance is a growing problem. The Centers for Disease Control and Prevention

(CDC) calls it “one of the world’s most pressing public health problems.” It’s especially a concern in

low-income and developing countries.

Antibiotic Resistance(Habboush Y, Guzman N.)

Recognition of issues related to the use of antibiotics has been present since their early

clinical introduction in the 1940s. Since then, the use of antimicrobials and often inappropriate use of

these have been increasing. Antibiotic resistance in the United States kills approximately 23,000

patients a year and incurs over $20 billion in additional medical expenses. Antibiotic stewardship was

established to combat this trend and was recognized in 1996 to draw attention to the rising incidents in

mortality and morbidity associated with inappropriate use of antibiotics. Antimicrobial agents are at

least partially responsible for the development of serious infections, such as Staphylococcus aureus,

vancomycin-resistant enterococci, extended-spectrum B-lactamase producing Enterobacteriaceae, and

other infectious agents. The focus of the stewardship programs is to improve clinical outcomes,

decrease antibiotic resistance, and decrease healthcare costs. In 2007, stewardship programs were

nationally recognized and reinforced by the publication of the stewardship guidelines from the

Infectious Disease Society of America (IDSA) in association with the Society of Healthcare

Epidemiology of America (SHEA). These guidelines were helpful in developing an institutional

program to enhance antimicrobial stewardship.

Antibiotic resistance occurs when bacteria evolve to evade the effect of antibiotics through

multiple different mechanisms. Dissemination of antibiotic resistance genes is an ecological and

public health concern. Certain bacteria are able to neutralize an antibiotic by altering its component to
render it ineffective. Others might be able to export the antibiotics out of the bacteria, and some can

modify their outer structure and receptors so that antibiotics cannot attach to them. These mechanisms

might lead to some bacteria surviving the use of the specific antibiotic and developing a resistance

that can be passed to other bacteria as they multiply. Bacteria also can become resistant through

mutation of their genetic material.

In the past, medicine was able to stay ahead of antimicrobial resistance through research and

the development of new agents to overcome the different types of resistance patterns; however, with

the recent development of vancomycin-resistant enterococci and the new subtypes of methicillin-

resistant Staphylococcus aureus, antibiotic resistance is more prevalent and only can be minimized

through stewardship. To combat the rising use of antibiotics, medical and public health professionals

have to collaborate to reduce the inappropriate use of antibiotics. Physicians will have to balance the

risks of not treating or inadequately treating against the risk of antibiotic use regarding adverse

effects, drug interactions, cost, and antibiotic resistance.

Global Contributors to Antibiotic Resistance (J Glob Infect Dis. Et al. July-Sept 2019)

Infectious diseases have been a major cause of mortality historically. However, developments

within medicine and public health during the 20th century helped to markedly reduce the burden

associated with infectious diseases. In 1900, infectious diseases accounted for one-third of all deaths

out of the top 10 leading causes of death.On the contrary, in 2014, noncommunicable diseases such as

cardiovascular illness and cancers accounted for the majority of deaths. Key medical breakthroughs,

such as the discovery of penicillin, as well as improved sanitation played crucial roles in reducing the

mortality associated with infections.The purpose of this study was to conduct a qualitative literature

review of the various factors contributing to the rise in antibiotic resistance globally. This paper aims

to highlight that there are distinct factors which play a role in increasing the prevalence of antibiotic

resistance in developing and developed countries and argues that more measures need to be taken at
international and national levels to improve the regulatory framework to slow the development of

antibiotic resistance and augment research into novel therapies.

PUBMED was used to identify primary research, systematic reviews, and narrative reviews

published between 1963 and January 2017. Search terms included antibiotic resistance, antimicrobial

resistance, superbugs, multidrug-resistant organisms, developing countries, developed countries.

Publications from different countries were included to ensure generalizability. Publications were

excluded if they did not mention factors causing resistance, focused on the molecular basis of

resistance, or if they were case reports. Publications in languages other than English were also

excluded. Publicly available reports from national and international health agencies were used

Overall, multiple factors, which are distinct for developing and developed countries,

contribute to the increase in the prevalence of antibiotic resistance globally. The results highlight the

need to improve the regulatory framework for antibiotic use and research globally.

The Negative Impact of Antibiotic Resistance (N. D. Friedman, et al. clin microbiol infect.

2016 May)

Antibacterial therapy is one of the most important medical developments of the twentieth

century; however, the spread of resistance in healthcare settings and in the community threatens the

enormous gains made by the availability of antibiotic therapy. Infections caused by resistant bacteria

lead to up to two-fold higher rates of adverse outcomes compared with similar infections caused by

susceptible strains. These adverse outcomes may be clinical or economic and reflect primarily the

failure or delay of antibiotic treatment. The magnitude of these adverse outcomes will be more

pronounced as disease severity, strain virulence, or host vulnerability increases.

The negative Impacts of antibacterial resistance can be measured at the patient level by

increased morbidity and mortality, at the healthcare level by increased resource utilization, higher
costs and reduced hospital activity and at the society level by antibiotic treatment guidelines favouring

increasingly broad-spectrum empiric therapy. In this review we will discuss the negative impact of

antibiotic resistance on patients, the healthcare system and society.

Antibiotic resistance is a public health concern around the world. The number of bacteria that

are resistant to antibiotics is increasing.Infections caused by resistant bacteria may be resistant to

more than one antibiotic. Few new antibiotics are being developed. So it is important that all

Canadians help maintain the effectiveness of the antibiotics we have. We can do this through

responsible antibiotic use, and infection prevention and control.

What are the side effects of antibiotics? (Medically reviewed by Jennie Olopaade, PharmD, RPH-By

Jennifer Huizen – Updated on December 17, 2021)

Healthcare practitioners prescribe antibiotics to prevent and treat bacterial infections. Most of

the side effects associated with antibiotics may cause severe side effects in some people that require

medical attention. Antibiotics are generally safe, and doctors prescribe them to stop the growth of

bacteria; for example, to treat bacterial infections, such as strep throat, urinary tract infections (UTIs),

and certain skin. However, antibiotics can cause side effects, ranging from minor to severe to life

threatening. According to the Centers for Disease Control and Prevention (CDC), 1 in 5 Trusted

source medication-related emergence room visits are due to antibiotic side effects. This article

explores common and rare side effects of antibiotics, including long term side effects and when to

consult a doctor.

Treating a UTI with antibiotics can sometimes lead to a vaginal yeast infections. It is generally a good

idea to avoid alcohol while on certain antibiotics. Drinking alcohol while taking antibiotics can

decrease the effectiveness and increase the chance of antibiotic side effects. Teeth staining is

irreversible in adults because their teeth do not regrow or change. However, as bones remodel

themselves continuously, it is possible to reverse the staining.

A person should talk with a doctor”about switching medications if taking antibiotics causes tooth

discoloration or staining.Antibiotic resistance happens when germs develop the ability to overcome

the antibiotic’s ability to kill them. That means the germs continue to grow.

Some infections caused by an antibiotic-resistant strain of bacteria do not respond to any available

antibiotics. Antibacterial-resistant infections can be severe and potentially life threatening.Antibiotics

are prescription medications that kill or prevent bacteria from growing. Doctors prescribe antibiotics

to treat bacterial infections, such as strep throat or skin infections.

Antibiotics commonly produce side effects that range from mild to severe, so a person should only

take them when a doctor deems them necessary.

People should report any antibiotic side effects to their doctor or healthcare professional.

Conceptual Framework

ORAL LITERATURE

More specifically, during periodontitis, antibiotics are used, often in association with

periodontal debridement, to reduce disease-associated periodontopathogens. However, international

guidelines are not unanimous in recommending the use of local and/or systemic antimicrobials to

reduce infection by oral bacteria, especially in cases in which there is a danger of spreading systemic

infection such as cellulitis, diffuse swelling, and abscesses. The lack of consensus is mainly due to the

side effects of antibiotic therapy in dentistry, maybe due to recent scientific evidence regarding the

development of bacterial resistance to antibiotics.

PRODUCT

The problem of antibiotic resistance has become a challenge for our public health and society;

it has allowed infectious diseases to re-emerge as a risk to human health. New antibiotics that are
introduced to the market face the rise of resistant pathogens after a certain period of use. The

relatively fast development of resistance against some antibiotics seems to be closely linked to their

microbial origin and function in nature. Antibiotics in clinical use are merely products of

microorganisms or derivatives of microbial products. The evolution of these antimicrobial compounds

has progressed with the evolution of the respective resistance mechanisms in microbes for billions of

years. Thus, antimicrobial resistance genes are present within the environment and can be taken up by

pathogens through horizontal gene transfer.

The global impact of antibiotic resistance is potentially devastating, threatening to set back

progress against certain infectious diseases to the pre-antibiotic era. Although most antibiotic-resistant

bacteria originally emerged.

INPUT PROCESS OUTCOME

Among respondents, 60.5%
reported having heard of the
term 'antibiotic resistance', but
only 11% had heard of the
abbreviation 'AMR'. About half
of the respondents were aware
that resistance occurs when
bacteria become resistance to
the antibiotics.
Antibiotic resistance happens
when germs like bacteria and
fungi develop the ability to
defeat the drugs designed to
kill them. Resistant infections
can be difficult, and sometimes
impossible, to treat Anti
microbial resistance is a
naturally occurring process.
These bacteria may infect
humans and animals, and the
infections they cause are harder
to treat than those caused by
non-resistant bacteria.
Antibiotic resistance leads to
higher medical costs, prolonged
hospital stays, and increased
mortality.

Assumption of the study

A Study on the repercussion of the Misuse of Antibiotics to the Emergence of Antibiotic

Resistance in Barangay Lamao’’

1. The lack of awareness of the patient in taking antibiotics

2. There are various effects by improper taking of antibiotics.

3. Improper taking of antibiotics can change bacteria so much that antibiotics don't work against them.

If patient keeps taking antibiotics in wrong way, the resistance of bacteria will be even more stronger.

4. However the patient that knowledgeable of taking antibiotics the bacteria in their body will be

easily destroy.

Definition of Terms

For better understanding of the study, the following words are conceptually and/or

operationally defined.

Repercussion. As used in the study, This term refers to an action or effect given or exerted in

return : a reciprocal action or effect according to Merriam-Webster Dictionary.

Misuse of Antibiotics. It refers to the non proper taking of antibiotics and alarming its

existence to the intended learners.

Antibiotic Resistance. This pertains to the developed of Antimicrobial resistance it happens

when germs like bacteria and fungi develop the ability to defeat the drugs designed to kill them. That

means the germs are not killed and continue to grow according to Centers for Disease Control and

Prevention.

Emergence. As used in the study, This term refers to the fact of something becoming known

or starting to exist.

Notes in Chapter Two:

Alividza V, Marian V, Ahmad R, et al. 2018. “Investigating the impact of poverty on colonization and

infection with drug-resistant organisms in humans: a systematic review.Infect dis Poverty. 7(1):76.

Pubmed.hs

Allel K, Garcia P, Labarca J, et al. 2020. “Socioeconomic factors associated with antimicrobial

resistance of Pseudomonas aeruginosa, Staphylococcus aureus, and Escherichia coli in Chilean

hospitals (2008 - 2017)” National Library of Medicine. Retrieved from

https://pubmed.ncbi.nlm.nih.gov/32973892/

Davies J, Davies D. 2010. “Origins and Evolution of Antibiotic Resistance”. National Library of

Medicine. Pubmed Central. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2937522

Holmes A., et al. 2016. “Understanding the mechanism and drivers of antimicrobial resistance”.The

Lancet. National Library of Medicine. Retrieved from https://pubmed.ncbi.nlm.nih.gov/26603922/

Ilic K, Jakovljevic E, Skodric V. “Social-economic factors and irrational antibiotic use as reasons for

antibiotic resistance of bacteria causing common childhood infections in primary healthcare. Eur

Pediatr. 171(7):767-777 Pubmed.

Irfan M, Almotri A, Alzeyadi Z. 2022. “Antimicrobial Resistance and its Drivers — A Review”.

Antibiotics 2022, 11, 1362. Retrieved from https://doi.org/10.3390.antibiotics11101362

Jama K. 2022. “Socioeconomic Determinants of Antibiotic Resistance. Ausburg University. Retrieved

from https:// idun.ausburg.edu/etd/1258

Klein E, Boeckel T, Martinez E, et al. 2018. “Global Increase and Geographic Convergence in

Antibiotic Consumption Between 2000 and 2015”. Elsevier. Proceedings of the National Academy of

Sciences of the USA. E3463 - E3470. Vol 115. Retrieved from

https://jhu.pure.elsevier.com/en/publications/global-increase-and-geographic-convergence-in-

antibiotic-consumption-between-2000-and-2015

Bierbaum G, Blau K, et al. 2020. “Colistin-resistant Enterobacteriaceae Isolated From Process Waters

and Wastewater From German Poultry and Pig Slaughterhouses”.Frontiers vol 11. Retrieved from

https://www.frontiersin.org/articles/10.3389/fmicb.2020.575391
Okeke I, Lamikanra A, Edelman R. 1999. “Socioeconomic and Behavioral Factors Leading to

Acquired Bacterial Resistance to Antibiotics in Developing Countries. PubMed. Retrieved from

https://www.researchgate.net/publication/13208729

Trotter Alexander, et al. 2019. “Recent and emerging technologies for the rapid diagnosis of infection

and antimicrobial resistance”. National Library of Medicine. Retrieved from

https://pubmed.ncbi.nlm.nih.gov/31077935/

“Repercussion.” Merriam-Webster.com Dictionary, Merriam-Webster, https://www.merriam-

webster.com/dictionary/repercussion. Accessed 4 May. 2023.

Cambridge Dictionary “Emergence” https://dictionary.cambridge.org/us/dictionary/english/emergence

Centers for Disease Control and Prevention. CDC twenty four seven. Saving Lives, Protecting People

Antimicrobial Resistance 2022,

https://www.cdc.gov/drugresistance/about.html#:~:text=Antimicrobial%20resistance%20happens

%20when%20germs,and%20sometimes%20impossible%2C%20to%20treat

Nicolas Houy, Julien Flaig. (2021) Hospital-wide surveillance-based antimicrobial treatments: A

Monte-Carlo look-ahead method. Computer Methods and Programs in Biomedicine 204,

106050.https://doi.org/10.1164/ajrccm.156.4.ed-14

Niederman M. “Is Crop Rotation of Antibiotics the Solution to a Resistance Problem in the ICU?”.

https://www.atsjournals.org/doi/10.1164/ajrccm.156.4.ed-14

P C. Lee Ventola, et al. April 2015. “The Antibiotic Resistance Crisis”, National Institutes of Health.

https://www.ncbi.nlm.nih.gov
 CHAPTER 3

RESEARCH METHODOLOGY

Research Design

This study aimed to preserve and document the Study on the repercussion of the Misuse of

Antibiotics to the Emergence of Antibiotic Resistance in Lamao, Bataan using a Phenomenological

style of research.

As defined by Creswell (2009), “phenomenology is a research strategy of inquiry in which the

researcher identifies the essence of human experiences about a phenomenon as described by

participants” (p. 13).

As described by Moustakas (1994), “Phenomenology seeks meanings from appearances and

arrives at essences through intuition and reflection on conscious acts of experience, leading to ideas,

concepts judgments, and understandings” (p. 58). As such, the focus of this phenomenological

research study will be to understand the extent to which the current system contributes to an

educational achievement gap for foster children through the experiences of these foster children.

A phenomenological research design provides an understanding of the themes and patterns

portrayed by the study’s participants. The participants in the study will be asked openended interview

questions, such that their specific experiences can be identified. Moustakas (1994) stated, “The

empirical phenomenological approach involves a return to experience in order to obtain

comprehensive descriptions that provide the basis for a reflective structural analysis that portrays the

essences of the experience” (p. 13).

 According to Groenewald (2004), “The operative word in phenomenological research is

described. The aim of the researcher is to describe as accurately as possible the phenomenon,

refraining from any pre-given framework, but remaining true to the facts. The phenomenologist is

concerned with understanding social and psychological phenomena from the perspectives of people

involved” (p. 5). A variety of methods can be used in phenomenological research that includes

interviews and focus group meetings. This research will use these methods to address the research

questions.

Population of sampling

The population in the study is the Barangay Lamao who have a population of 19,946

A purposive sample is a quota sumpling that is selected to those only who used antibiotics.

And using the rule of thumb we will select 10 persons in Barangay Lamao to conduct this study.

Research Instrument:

To efficiently gather information and carry out and facilitate and effective data collection, the

researchers will utilize interviews and questionnaires to their participants.

The researchers will use semi structured interviews to steer their subjects into delving on their

practices as an individual contributing to the factors which might result to antibiotic resistance and

their shared and aligned conceptions as a part of a family.

Furthermore, the researchers will conduct focus groups to 1. assess the people’s awareness

living in the community on the existence of resistance, and 2. validate the authorities’ efforts to

mitigate and control its emergence.

 To systematically introduce the subjects to the research problem, the researchers will first

gather demographic informations:

1. What is your age?

2. What is your gender?

3. What is your occupation?

4. What is your highest educational attainment?

These informations may ba later used to analyze the effect of demographics in the research

problem. Moreover, to better understand the knowledge of the people on how to use antibiotics, the

following questions may be asked:

1. What do you know about antibiotics?

2. Have you ever taken antibiotics before?

3. Have you been instructed by a physician on how to use antitbiotics?

4. Do you believe that antibiotics can cure other type of illnesses aside from the ones caused by

bacterial infections, say like cough or common colds or flu?

5. Have you ever stopped taking antibiotics before the end of the prescribed period?

6. What are the reasons why you decided to stop the medication?

7. Have you tried using antibiotics on other illnesses other than that of what it is prescribed for?

What are those instances?

To further validate the reasons why the subjects will tend to neglect proper use of

antimicrobial drugs, the following may be added:

1. In the recent time that you have taken antibiotics, do you remember what was your illness?

2. For how long are you instructed to take the medication?

3. How much is your allotment for the acquisition of the drugs?

 4. Were you given assistance by the community clinic?

5. Were you able to finish the entire course as prescribed by the doctor?

6. Do you have access to other forms of treatment or has tried other treatment on your condition

other than antibiotics?

To examine the awareness of the subject and the community to the possibility of AMR, the

following may be inquired:

1. What do you know about antibiotic resistance?

2. Do you know the causes of resistance?

3. Do you think that the community may be exhibiting any form of resistance?

4. Do you think this should be a health concern which we as primary consumers should take

seriously?

In addition, researchers may seek the following information from the authorities and leaders

of the community in order to check the availability of accessible healthcare for the patients:

1. Do you have a community clinic?

2. Does anyone in the locale have access to the clinic?

3. Do you have stationed medical health professionals on the clinic?

4. How many professionals are available?

5. Are antibiotics readily available in the clinic?

6. Have you experienced a problem on supply of medicines?

7. Is there a campaign or drive within the community to help raise awareness to the proper use

of antibiotics? What are those campaigns?

8. What services does the community need which relates to this problem?

Validity and Reliability

 Rigor in a study comes from the validity of the research, the reliability of the findings, and the

use of triangulation in data collection (Trochim & Donnelly, 2006). A valid work must be supported,

acceptable, and convincing. Each piece of research adds to their particular discipline and often does so

by adhering to the guidelines for proper research.

According to Trochim and Donnelly (2006), validity refers to the best estimate of the truth of any

proposition or conclusion or inference described in the research. Validity will be used to assess the

quality of the research conclusions. The internal and external validity of the research will be

evaluated to determine the cause and effect relationship between the variables identified in the

hypotheses.

According to Creswell (2003), validity plays a significant role in a qualitative study in that it

is a powerful source used to determine the accuracy of the study’s findings. To increase the validity

of this study, triangulation will be used. Triangulation is the method of using multiple research

approaches and methods. Such a technique can help in overcoming the bias and unproductiveness of

a single method. It can be applied to both quantitative validation and qualitative validation (Yin,

2003).

Validity and reliability involve checking the status of the data collected to determine if they

are valid and reliable (Struwig & Stead, 2004). Internal validity calculates the extent to which the

responses from the respondents reflect the same attributes (Fink, 2008). The triangulation technique

will ensure the validity and reliability of the data gathered through the questionnaire, which asked

multiple questions of the target sample to determine the integrity of the answers (Fink, 2008). The

sources for the historical qualitative research taken from official company websites and peer-reviewed

journals ensured that the information used in the literature review was accurate and valid (Creswell,

2003; Trochim & Donnelly, 2006). Valid research instruments are paramount to collection of reliable

data (Polit & Benk, 2004). The researcher will validate the questions in the survey instrument before

the commencement of data collection.

Data Gathering Procedure

After the research-made questionnaire was validated, the researchers went around and asked

questions to people who were knowledgeable and compatible with their questions they also used

recording with the consent of the interviewees. The researchers were able to successfully ask

questions to different people and gather different information and answers from the interviews.

Data Analysis

Data analysis process is a way to discover “patterns, coherent themes, meaningful categories,

and new ideas and in general uncovers better understanding of a phenomenon or process” (Suter,

2006, p. 327). “The purpose of interviewing is to find out what is in and on someone else’s mind…

We interview people to find out from them those things we cannot directly observe” (Patton, 1990, p.

278). Data will be reviewed after the focus group discussion, analyzed, and interpreted into themes

and meanings to lay the foundation of codification. Creswell (2005) suggested that content analysis

categorizes, synthesizes and interprets qualitative text data by describing.

Neuman (2003) described the process of data analysis as a means for looking for patterns to

explain the goal of the studied phenomena. The analysis of data used responses from the focus group

discussion. From these sources, the emerging themes will be categorized and coded. Once the

categorization is completed, the data will be coded according to the indicators from the literature. This

study used an open-coding system to analyze participants’ narrative responses line-by-line, phrase-by-

phrase and word-by-word (Creswell, 2003; Suter, 2006)

 The study used NVivo 8 (QSR International) qualitative data analysis software to evaluate the

focus group transcripts. The software provided a systematic analysis of the collected qualitative data.

As Patton (2002) stated in his book Qualitative.

Transcription of data

Transcription is a translation between forms of data. In the social sciences, this is most

commonly converting audio recordings of interviews or discussions to text format.

Whilst audio-transcription is often part of the analysis process, it also enhances the sharing

and reuse potential of qualitative research data. It is recommended that researchers make

transcriptions of interviews; full-transcriptions significantly extend the potential for analysis and the

re-use of a research collection, both by the original researchers and by secondary users.

Organization of data

Data organization is a process of organizing raw data, by classifying them into different

categories. This raw data includes the observations of variables. For example, arranging the marks

obtained by students in different subjects is data organization.

As time passes and our volume of data increases, the time consumed to search for any

information from the data source increases if it hasn’t been organized already. Let us consider the

following example to understand the concept and need for data organization.

Interpretation of data

In some studies, researchers will need to make decisions about which data to analyse (for

instance the amount of information collected in an ethnographic study may be so great that it would

not be possible to analyse all of it before funding runs out). It is important that such decisions are
made on the basis of relevance to the research question, and in discussion with the rest of the research

team if there is one, and that they are reported.

Similarly, there a times when researchers must “sample” material when they are reporting

their findings. For example, in an interview study authors may need to illustrate the emergent themes.

There is always a temptation to choose the most extreme or memorable quotation; however quotations

should be chosen because of how well they represent a theme. Furthermore the temptation to quote

only one particularly articulate individual should be resisted – it is better to take quotations from a

range of participants and to make all these choices clear in reporting. For example in a study of

women’s perceptions of consenting for surgery, the authors needed to illustrate several themes - some

women perceived surgery as the fulfilment of a desire, some saw surgery as “rescue” from a problem,

and some felt that surgery was imposed on them against their wishes1. These viewpoints are

illustrated in the study by a range of quotations from different participants. You might like to check

how well researchers explain their choice of illustrative quotations in other literature you read.

Notes In Chapter 3

Validity and Reliability Habiba M, Jackson C, Akkad A, Kenyon S, Dixon-Woods M. (2004)

Women's accounts of consenting to surgery: is consent a quality problem? Qual Saf Health Care.

Dec;13(6):422-7

ByjusMathhttps://byjus.com/maths/data-organization/

Bucholtz, M. (2000) The Politics of Transcription. Journal of Pragmatics 32: 1439-1465.

Datanalysis of qualitative research

https://precisionconsultingcompany.com/wp-content/uploads/2018/10/Sample-of-a-Qualitative-

Methodology-Section-1.pdf
 Chapter 4
Presentation, Analysis, and Interpretation of Data

Introduction

For clarity and comprehensiveness of presentation, this chapter is divided into

(4) four parts corresponding to the specific questions raised in chapter 1 of the study.

Part 1 deals with Category 1 that reveals the reasons of the people behind
the misuse of antibiotics.

Part 2 deals with Category 2 that shows the effects of antibiotic resistance to
a person.

Part 3 deals with Category 3 that includes the impact of repercussions of a

person in misuse of antibiotics into their health.

Part 4 deals with Category 4 that shows the danger of getting misuse of
antibiotics.

1 Category: Reasons
Code: Personal
Code: Beliefs
Code: Undetermined

Question Reponse Code

What are the reasons Respondent 1: Many individuals use

behind antibiotic misuse?
antibiotics without first consulting to a
physician. They shared a belief that
antibiotics were efficient in treating any Beliefs
medical condition or bacterium. They
believed that antibiotics are mild like
vitamins, so they could take them without
a doctor’s prescription.

Respondent 2: Using antibiotics even if Personal

not prescribed by the doctor.

Respondent 3: Some reasons why

misusing of antibiotics are it can be used Personal
as an amphetamine or for disease/illness
cured. If someone diagnose one severe
illness, antibiotics maybe use without any
doctor’s prescription, that’s why antibiotic
may lead to misuse and it can be used
also as a drug abuse contents.

Respondent 4: Not taking the medicine at

the right time and not taking it continuously Personal
and not finishing the prescribed length of
time.

Respondent 5: It’s actually depends

because some use antibiotics as actually Personal
know for suicide they are a lot of addicted
to the use of antibiotics such as misuse
but I think the main reason is addiction.

Respondent 6: Unnecessary prescribing.

Sometimes doctors may prescribe an Undetermined
antibiotic for an illness that cannot be
cured by antibiotics such as the common
cold or flu. The types of antibiotics is can
lead to bacteria developing resistance to
certain types of antibiotics.

Respondent 7: Ang labis na paggamit ng

antibiotics ay nangyayari dahil sa maling Beliefs
malawakang paniniwala na ang mga ito ay
kapaki-pakinabang para sa isang malawak
na hanay ng mga kondisyon at dahil
maraming mga manggagamot ang
handang mag reseta ng mga antibiotics
kung ang mga pasyente ay humingi ng
gamot.

Respondent 8: Kapag mali ang pag inom Personal

mo ng antibiotic pwedeng mag cause iyon
sa immune system natin pwede siyang
humina at tsaka kailangan ang antibiotic
ay iniinom sa tamang binibigay ng doktor
sa akin.

Respondent 9: Ang mga ilan ay hindi na

nag papareseta sa mga doctor o hindi na Personal
nag papacheck up basta nalang sila nag
tatake ng antibiotics kahit hindi naman
tama ito para sa nararamdaman nilang
sakit.

Respondent 10: Ang iba siguro dahil sa

lack of knowledge, na akala nila yung Personal
antibiotic is parang pwede sa lahat ng
sakit.
 The data gathered shows that the majority of the respondents decided on their

personal reasons, and few of the respondents decided base on the beliefs in terms of

reasons behind antibiotic misuse. There are also some people in Lamao who decided with

Undetermined.

Generally, the category reason behind the antibiotic misuse in Lamao reflected as

personal reasons. The findings supported by The Centers for Disease Control and

Prevention (CDC) by (Habboush Y. & Guzman N.), Antibiotic resistance in the United States

kills approximately 23,000 patients a year and incurs over $20 billion in additional medical

expenses. Antibiotic stewardship was established to

combat this trend and was recognized in 1996 to draw attention to the rising incidents

in mortality and morbidity associated with inappropriate use of antibiotics.

2 Category: Effects
Code: Personal
Code: Knowledge
Code: Self-Awareness

Question Response Code

How are people affected
by antibiotic resistance?
Respondent 1:A lot of people will start to
live in a world where we can't fight against Knowledge
bacteria anymore using antibiotics. Bacteria
will start to grow rapidly and destroy us
humans once they start to get immune to
the antibiotics, or what we call antibiotic
resistance.

Respondent 2:It is more difficult to find a

new drug that works for the disease and the Personal
next treatment will be more expensive.
Respondent 3:Some people by antibiotic
resistance such as it can cause stress, Knowledge
organ damage insanity or even being an
drug addiction.

Respondent 4: I will not resist the medicine Personal

the next time I get sick again.

Respondent 5: Antibiotic Resistance when

the bacteria in the body goes like grown to
be immune, when you're like–the bacteria
on your body grows to be immune to those
antibiotic you take such as maintenance
every day they won't work anymore In my
experience actually I've had several anti -
depressant that I've taken and then my Knowledge
doctor/psychiatrist actually changes them a
lot that's why I have to go to therapy
monthly sometimes weekly whenever such
changes my medication to keep track if ever
my medication still work for my situation. I
used to take fluoxetina it was anti-
depressant but now I take an antipsychotics
called serotia which helps me sleep at night

Respondent 6: People are affected by

antibiotic-resistant bacteria in a variety of
ways. This includes the increased risk of
long-term health problems resulting from
antibiotic-resistant infections, the increased
economic cost associated with treating
antibiotic-resistant infections, and the
increased risk of bacterial evolution and Knowledge
spread of mutations across species.
Resistant bacteria can lead to increased
rates of hospitalizations, more costly
hospital stays, and an increased risk of
death in some cases. When resistant
bacteria are present, the antibiotics that are
available may not be effective, making
diagnosis and treatment more difficult.

Respondent 7:Ang mga pamamaraang ito

ay may malaking panganib ng impeksyon, Self-
at hindi matatanggap ng mga pasyente ang Awareness
mga ito kung walang mabisang antibiotic.

Respondent 8: resistance, yung bacteria

kasi ng antibiotic kapag uminom kasi ng
antibiotic kailangan nasa tamang proseso
kungnilang araw, almost 7 days kailangan Self-
inumin mo yung gamot na yon, 2× a day. Awareness
Then pag umiinom ka non kailangan busog
ka kasi pwedeng magkaroon yon ng side
 effect sa katawan natin. Tapos yung
kanyang imune system mapapahina. Tsaka
yung sakit nya babalik at babalik pa rin.

Respondent 9: Naaapektuhan nito ang

ating sakit na nararamasan dahil imbis na
gumaling ay lalo lang itong nagiging virus sa Personal
katawan dahil sa,maling pag gamit o pag
inom ng antibiotic.

Respondent 10: Mas mahihirapan nito

yung mga tao kasi may posibilidad na mas Knowledge
dumami pa yung sakit dahil hindi na
tumalab yung antibiotic.

The data gathered shows that the majority of the respondents decided based on their

knowledge, and few of the respondents decided based on their personal reasons in terms of

people affected by antibiotic resistance. There are also some people in Lamao who decided

with self-awareness.

Generally, The category effect behind on how people affected by the antibiotic

resistance in Lamao reflected on their knowledge. The findings supported by The Antibiotic

Resistance Crisis (C. Lee Ventola, et al.) (2015), The rapid emergence of resistant bacteria

is occurring worldwide, endangering the efficacy of antibiotics, which have transformed

medicine and saved millions of lives. Many decades after the first patients were treated with

antibiotics, bacterial infections have again become a threat.

Category: Consequence
Code: Personal
Code: Knowledge
Code: Undetermined

Question Response Code

How will the repercussion Respondent 1: Some of my organs will

of the misuse of be destroyed, and it will begin to Personal
Antibiotics effect your malfunction, which will cause my death.
health? Respondent 2: You won't get better from
your illness right away and it might get Knowledge
worse.

Respondent 3: It can affect someone’s

health beacause of misleading or misuse Knowledge
of antibiotic by someone’s having an
stress or depression.

Respondent 4: My sick will get worse. Personal

Respondent 5: I think there are a lot of

reasons as well but depending on me, I
quite personal i actually tried to take
those antibiotics to off my self and it cost
a lot of problem specially like neurological
problems after the misuse of those
antibiotics I actually start to forget easily Personal
more which is a really not really rare side
effect but it wasn't side effect that was
often co-related with my medication so it
had a lot of consequences such as me
forgeting things I had to supervise when I
took my medication after that happen to
avoid same problem happening again.

Respondent 6: The misuse of antibiotics

can have detrimental effects on your
health. Overuse of antibiotics can reduce
their effectiveness and lead to increased
rates of antibiotic resistance. This can
leave you more vulnerable to infections Knowledge
that cannot be effectively treated,
meaning that you could suffer for longer
and the infections could become more
severe. In addition, inappropriate use of
antibiotics may have other side effects
such as nausea, diarrhoea, and allergies.

Respondent 7: Nakakaapekto ito sa

kalusugan ko dahil sa maling pag inom
ng antibiotics ay maaring masira ang Personal
aking organs o maapektuhan nito ang
aking utak dahil sa,mga chemicals na
naka paloob dito

Respondent 8: Kapag nga hindi mo

ininom sa tamang proseso ang antibiotic,
katulad ng kay emjay, binigyan sya ng
antibiotic kailangan 7days nyang iinumin
kasi yung bacteria nya pag huminto ka
noon, sa susunod hindi na Ito tatanggapin
ng katawan natin. Tapos yung bacteria Undetermined
nya lalong dadami tapos ang magiging
cause nito pag sobra naman,
 nagkakaroon ng diarrhea. Advance
naman yon sa mga taong hindi
nakakadumi nang maayos. Pero kapag
uminom ka sa tamang proseso, magiging
madali ang epekto sa katawan ang
antibiotic.

Respondent 9: nasisira nito ang ating

utak pati na ang kidney dahil sa mga
mataas na chemicals na nakapaloob sa Personal
anibiotic na nainom nila lalo na kung
sobra ito para sa ating katawan.

Respondent 10: Mag kakaroon yung

katawan ng tao ng antibiotic resistance,
kaya possible na hindi na tumanggap Knowledge
yung katawan mo ng kahit anong
antibiotic kahit na mag iba kapa.

The data gathered shows that the majority of the respondents decided on their

personal reasons, and few of the respondents decided base on their knowledge in terms of

repercussion of the misuse of antibiotic. There are also some people in Lamao who decided

with Undetermined.

Generally, The category consequence behind the repercussion of the misuse of

antibiotic in Lamao reflected on their personal reason. The findings supported by The

Negative Impact of Antibiotic Resistance (N. D. Friedman et al.) (2016) These adverse

outcomes may be clinical or economic and reflect primarily the failure or delay of antibiotic

treatment. The magnitude of these adverse outcomes will be more pronounced as disease

severity, strain virulence, or host vulnerability increases. The negative Impacts of

antibacterial resistance can be measured at the patient level by increased morbidity and

mortality, at the healthcare level by increased resource utilization, higher costs and reduced

hospital activity and at the society level by antibiotic treatment guidelines favouring

increasingly broad-spectrum empiric therapy.

Category: Threat
Code: Personal
Code: Self-awareness
Code: Knowledge
Code: Undetermined

Question Response Code

What are the danger of Respondent 1: Many individuals use

misuse of Antibiotics? antibiotics without first consulting to a
physician. They shared a belief that
antibiotics were efficient in treating any Undetermined
medical condition or bacterium. They
believed that antibiotics are mild like
vitamins, so they could take them without a
doctor's prescription.

Respondent 2: It is possible to develop Personal

antibiotic resistance and the drugs will not
be able to withstand the next time you get
sick again.

Respondent 3: Some dangers of

antibiotics misuse are being an
insanity ,abnormal heart beat and pulse Self-
rate. Danger of antibiotic misuse are Awareness
having a serious medical condition and
also caused of death or over fatal or
serious organ damage.

Respondent 4: My disease will get worse, Self-

I can lead to death. Awareness

Respondent 5: Most cases they would

cause either long term problems or death.
Most likely because if you misuse antibiotic Self-
that had given to you it will take them at Awareness
the right time or at the right dose they will
probably cause long term problems to your
health and even death.

Respondent 6:The misuse and overuse of

antibiotics can have a number of serious
and potentially dangerous consequences.
It can lead to antibiotic-resistant bacteria,
in which bacteria can develop resistance to
drugs used to treat them. This means that Knowledge
certain infections may no longer respond to
certain drugs, making them more difficult to
treat. Misuse of antibiotics can also
increase the risk of developing fungal and
bacterial infections, as well as leading to
certain health complications.
 Respondent 7:Ang maling paggamit nito
ay maaaring magdulot ng masamang
epekto. Wala nang tatalab na gamot kapag
tayo ay nagkasakit at magiging drug Personal
resistant na ang mikrobyo. at ang maling
pag gamit nito ay maaring maging sanhi ng
pag lala ng ating karamdaman.

Respondent 8:Sa liver natin, tapos pwede

syang masira kapag hindi maayos ang
kanyang pag-inom, then sa kidney pwede
rin sya kasi nagkakaroon ng side effect Self-
yon tapos maaari tayong magkaroon ng Awareness
iba't ibang sakit tsaka mas hihina ang ating
imune system.

Respondent 9:Maraming pwedeng

mangyare dahil sa maling pag gamit ng
antibiotic hindi lang sa pag kasira ng organ
o pag ka sira ng utak maari rin nitong Knowledge
mapalala ang kalagayan natin dahil sa
mga virus na naiipon sa ating katawan
dahil sa,maling pag gamit nito

Respondent 10: Mas mapapalakas nito

yung bacteria sa katawan mo, na imbis na
mamatay yung bacteria mas mapapalakas Personal
pa nito. Ang alam kodin pwedeng
maapektuhan yung organs eh.

The data gathered shows that the majority of the respondents decided on their self-

awareness, and few of the respondents decided base on their personal reason in terms of

the danger of misuse of antibiotic. There are also some people in Lamao who decided base

on their knowledge and also who decide with Undetermined.

Generally, the category threat behind the danger of misuse of antibiotics in Lamao

reflected their personal reason. The finding supported by The Danger of antibiotic overuse

(Durani Y.) (2023) Two major types of germs can make people sick: bacteria and viruses.

They can cause diseases with similar symptoms, but they multiply and spread illness

differently:

Bacteria are living organisms existing as single cells. Bacteria are everywhere and

most don’t cause any harm, and in some cases are beneficial. But some bacteria are
harmful and cause illness by invading the body, multiplying, and interfering with normal body

processes.

Chapter 5

SUMMARY OF FINDINGS, CONCLUSION AND RECOMMENDATION

Summary of findings

Generally, this study aims to address the reasons of antibiotic misuse leading to the

Emergence of Antibiotic Resistance in Lamao Limay, Bataan.

The researchers sought to answer to the following specific questions:

1.What are the reasons behind antibiotic misuse?

2. How are people affected by antibiotic resistance?

3. How will the repercussion of the misuse of Antibiotics effect your health?

4. What are the danger of misuse of Antibiotics?

The general intent of this study is to investigate the repercussion of the misuse of antibiotics

to the emergence of antibiotic resistance in Barangay Lamao with the focus on patient health after

taking antibiotics. Also this study is to know the causes of antibiotics resistance to a certain person.

The study limits its coverage on the patient in Lamao who used antibiotics only.

The data were organized through oral interview. The study limits its coverage on the patient

in Lamao who used antibiotics only.

Based on the data gathered, the following were the findings:

1.Reasons

The people in lamao who decided on their personal reasons that antibiotic misuse were the

main problem is many individuals use antibiotic without the prescribed by the doctor.
 2. Effects

The people in Barangay Lamao based on their experience on how they affected by the

antibiotic resistance through their health and lifestyle.

3. Consequences

The people in the community of Lamao based on their perspective as they take antibiotic

unintentionally wrong, that can leads to a long term health problem.

4. Threat

The people in Lamao stated that the danger of antibiotic misuse can lead to a severe illness or

even death.

Conclusion

Analysis of the result simply means that after of a study on the repercussions of the misuse of

antibiotics to the emergence of antibiotic resistance in Barangay Lamao a significant effect took place.

The significance of this study help people to be more aware and knowledgeable about antibiotic and

how the resistance work on their body as the repercussion is the main problem.

Further more, based on the findings that we gathered the possible problem here is the self-

medication practices because of the limited access to healthcare facilities or healthcare professionals

in Barangay Lamao might result in individuals resorting to self-medication. Without proper medical

guidance, individuals may not receive accurate diagnoses or appropriate prescriptions, leading to the

misuse of antibiotics.

Recommendation

By include infographics regarding antibiotic abuse and the rise of antibiotic resistance in

Lamao, along with a questionnaire to gather more informed and intelligible data for our study, this

research can be made even better. By giving the residents of Barangay Lamao knowledge from this

study, they can live better.