Combatting antimicrobial resistance

Antimicrobial resistance (AMR) is one of the top global public health and development threats identified by the World Health Organization (WHO). The agency estimated that bacterial AMR was directly responsible for 1.27 million global deaths in 2019, and contributed to 4.95 million deaths.

The WHO identifies misuse and overuse of antimicrobials in humans, animals, and plants as the main drivers in the development of drug-resistant pathogens. AMR affects countries in all regions and at all income levels. Its drivers and consequences are exacerbated by poverty and inequality, and low- and middleincome countries (LMICs) including the Philippines are most affected, the WHO said.

In 2019, there were 15,700 deaths attributable to AMR and 56,700 deaths associated with AMR in the Philippines. Our country has the 128th highest agestandardized mortality rate per 100,000 population associated with AMR across 204 countries. These are among the key findings of the Global Research on AntiMicrobial resistance (GRAM) project co-implemented by the University of Oxford and the Institute for Health Metrics and Evaluation (IHME).

Antimicrobials — including antibiotics, antivirals, antifungals, and antiparasitics — are medicines used to prevent and treat infectious diseases in humans, animals, and plants. AMR occurs when bacteria, viruses, fungi, and parasites no longer respond to antimicrobial medicines. As a result of drug resistance, antibiotics and other antimicrobial medicines become ineffective and infections become difficult or impossible to treat, increasing the risk of disease spread, severe illness, disability and death, the WHO explains.

AMR is a natural process that happens over time through genetic changes in pathogens. Its emergence and spread are accelerated by human activity, mainly the misuse and overuse of antimicrobials to treat, prevent, or control infections in humans, animals, and plants, the WHO stated.

Cultural misconceptions and inadequate regulation and enforcement of antibiotic use have shaped provider and patient attitudes and behavior that contribute to AMR in the Philippines, according to a letter to the editor published in the April 2022 issue of The Lancet Microbe. The op-ed authors, which included researchers from the Ateneo de Manila University, University of the Philippines Manila, and Philippine General Hospital, noted that self-medication is rampant in the country, with a prevalence rate ranging from 31% to 66%.

“Self-medication provides some semblance of healthcare, especially for low-income households that avoid economic and opportunity costs (i.e., productive work hours compromised by long clinic wait times) of medical consultation and diagnostics. Self-medication is also common among higher-income earners in LMICs, who have easier access to health information, and have the financial and social means to acquire medicine. Non-medical professionals commonly prescribe antimicrobials, and antibiotic sharing remains a common practice among Filipino families and communities,” the authors wrote.

The authors also noted that many Filipinos in rural areas still seek first-line treatment from traditional healers who provide herbal treatments, some of which contain suboptimal levels of antibiotics, as well as perform outdated practices such as crushing antibiotics to apply to skin injuries. These non-scientific practices may enhance pathogen resistance.

To address these challenges in combatting AMR in the country, the authors recommended legislation to regulate antibiotic prescription and dispensation and ensure accessibility and affordability of antimicrobials; partnerships between academic and private sectors to understand local AMR patterns and design culturally appropriate solutions; public education on AMR involving healthcare providers, public health experts, and community leaders, especially from rural regions; and the creation of global health networks to share best practices in addressing AMR in LMICs.

The research-based pharmaceutical industry believes that cross-sectoral collaboration is vital to address the growing threat of AMR. The education and cooperation of the public and healthcare professionals is paramount to identify and improve appropriate antimicrobial prescribing, dispensing, and adherence. Shared decision making with informed patients will help prescribers to ensure antibiotics are only given when needed.

Member states of the United Nations are called upon to establish national guidelines aligning with the WHO AWaRe guidance and to ensure that diagnostics are prioritized and made widely available to prescribers so that the effectiveness of new and old antibiotics is preserved, for as long as possible for as many patients as possible.

The establishment of national comprehensive surveillance systems will enable accurate characterization of resistance patterns globally. Sharing resistance data through international networks such as Global Antimicrobial Resistance and Use Surveillance System (GLASS) will allow for a better coordinated global effort to curb AMR.

TEODORO B. PADILLA is the executive director of Pharmaceutical and Healthcare Association of the Philippines (PHAP). PHAP represents the biopharmaceutical medicines and vaccines industry in the country. Its members are in the forefront of research and development efforts for COVID-19 and other diseases that affect Filipinos.