By the year 2050, it is estimated that 10 million people could die annually as a result of antimicrobial resistance (AMR).
AMR occurs when bacteria, viruses, fungi, and parasites no longer respond to medicines, making common infections harder to treat, and increasing the risk of disease spread, severe illness and death. Antimicrobials include antibiotics, antivirals, antifungals, and antiparasitics.
“If left unchecked, AMR can jeopardize the healthcare gains of society and pose a threat to health security, negatively affecting trade and damaging economies. This can lead to what experts have termed as the post-antibiotic era wherein minor infections may lead to death,” said Health Undersecretary Atty. Charade B. Mercado-Grande during a forum on Innovating for Antimicrobial Stewardship.
The forum was organized in support of the Department of Health and World Health Organization (WHO) celebration of World Antimicrobial Awareness Week this November. The forum, moderated by Dr. Arthur Dessi Roman of the Philippine Society for Microbiology and Infectious Diseases, also featured a compelling patient story.
When patient Maricel Buen was diagnosed with pneumonia in 2011, her doctor prescribed a weeklong antibiotic course. After three days, her cough was gone and she felt better. She stopped taking antibiotics. When her throat started to itch after several days, she took the remaining antibiotics.
A month later, her cough returned. She consulted another doctor who diagnosed her with pulmonary tuberculosis and prescribed a regimen of antibiotics. However, she was unable to complete the antibiotic course. A friend helped enroll Ms. Buen in the Directly Observed Treatment Strategy (DOTS) program, which provides free antibiotics to TB patients at the local health center.
However, after eight months on DOTS, she still had a cough. Her doctor ordered a sputum test, which still turned out positive for TB. Suspecting that Ms. Buen had developed drug-resistant TB, the doctor referred her to the Lung Center of the Philippines (LCP) for appropriate diagnosis and treatment.
Instead of going to LCP, Ms. Buen turned to a folk healer and self-medicated with cough syrup.
In 2013, someone noticed how thin and sickly Ms. Buen was and urged her to see a pulmonologist at LCP. “It was then that I realized my two children were still young. I did not want them to grow up as orphans,” Ms. Buen recalled in vernacular. She consulted the pulmonologist who referred her to a DOTS Center for a sputum test and GeneXpert test. The tests confirmed she had tuberculosis resistant to the antibiotic rifampicin.
Supported by nurses and fellow patients, Ms. Buen completed the 18-month Programmatic Management of Tuberculosis Preventive Treatment course.
Today, the 44-year-old massage therapist is a volunteer at the same DOTS Center, helping other TB patients complete their treatment. She is also the core leader of Breathe Free PH, which represents communities affected by tuberculosis, and advocates responsive and adequate policies and programs on TB.
“Consult a doctor before taking antibiotics. Never self-medicate and make sure to complete the antibiotic regimen prescribed by your doctor,” said Ms. Buen. She appealed to family members to remind their loved ones about taking their prescribed TB medications. Patients can also rely on the support and education provided by patient support groups.
Ms. Buen has placed a human face to the complex problem of antimicrobial resistance. The Association for Professionals in Infection Control and Epidemiology defines antimicrobial stewardship as a coordinated program that promotes the appropriate use of antimicrobials, improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
According to Ms. Grande, a holistic, multi-sectoral approach is vital in order to effectively address AMR. She cited effective communication, education, and awareness campaigns as well as innovation and research as among the key strategies of the Philippine Action Plan to Combat AMR: One Health Approach.
Teodoro B. Padilla is the executive director of Pharmaceutical and Healthcare Association of the Philippines (PHAP), which represents the biopharmaceutical medicines and vaccines industry in the country. Its members are at the forefront of research and development efforts for COVID-19 and other diseases that affect Filipinos.
