{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,9]],"date-time":"2026-02-09T21:39:02Z","timestamp":1770673142185,"version":"3.49.0"},"reference-count":34,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,5,9]]},"abstract":"<jats:p>The widespread unregulated use of antibiotics without medical consultation contributes to the burden of antibiotic resistance in Southeast Asian countries. This study investigated antibiotic use before hospital consultation. In a prospective observational study from February 2, 2015, to July 2, 2015, we enrolled febrile patients attending the emergency room in San Lazaro Hospital, Manila, the Philippines. A urine sample was collected and a bioassay was used to detect antibiotic activity in urine using <jats:italic>Bacillus stearothermophilus<\/jats:italic> (ATCC7953), <jats:italic>Escherichia coli<\/jats:italic> (ATCC25922), and <jats:italic>Streptococcus pyogenes<\/jats:italic> (ATCC19615). Patients or caregivers reported their medication history, clinical information, and socioeconomic status. During the study period, 410 patients were enrolled. The median (interquartile range) age was 14 (7\u201323) years and 158 (39%) reported prior antibiotic use, predominantly a beta-lactam antibiotic. A total of 164 (40%, 95% confidence interval [CI]: 35\u201345) patients were urine bioassay positive with any of three organisms. The <jats:italic>Bacillus<\/jats:italic> assay was the most sensitive, detecting 162 (99%, 95% CI: 96\u2013100) cases. Among bioassay positive patients, dengue (<jats:italic>N<\/jats:italic> = 91, 55%, 95% CI: 48\u201363) was the most frequent diagnosis, followed by other viral infections, including measles, rubella, and mumps (<jats:italic>N<\/jats:italic> = 17, 10%, 95% CI: 6\u201316). Patients with a positive bioassay were significantly more likely to be from the lowest-income group (adjusted odds ratio [AOR]: 1.7; 95% CI: 1.1\u20132.6) and required hospital admission (AOR: 2.1; 95% CI: 1.3\u20133.5). Unnecessary antibiotic use for febrile illnesses before hospital consultation is common in a low-income, highly populated urban community in Manila. Education targeting this group should be implemented to reduce unnecessary antibiotic use.<\/jats:p>","DOI":"10.4269\/ajtmh.17-0564","type":"journal-article","created":{"date-parts":[[2018,3,6]],"date-time":"2018-03-06T07:00:23Z","timestamp":1520319623000},"page":"1512-1519","source":"Crossref","is-referenced-by-count":14,"title":["Frequent Community Use of Antibiotics among a Low-Economic Status Population in Manila, the Philippines: A Prospective Assessment Using a Urine Antibiotic Bioassay"],"prefix":"10.4269","volume":"98","author":[{"given":"Nobuo","family":"Saito","sequence":"first","affiliation":[{"name":"Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan;"},{"name":"School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Noriko","family":"Takamura","sequence":"additional","affiliation":[{"name":"School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Grace P.","family":"Retuerma","sequence":"additional","affiliation":[{"name":"San Lazaro Hospital, Manila, Philippines;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carina H.","family":"Frayco","sequence":"additional","affiliation":[{"name":"San Lazaro Hospital, Manila, Philippines;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul S.","family":"Solano","sequence":"additional","affiliation":[{"name":"School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cherlyn D.","family":"Ubas","sequence":"additional","affiliation":[{"name":"School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arianne V.","family":"Lintag","sequence":"additional","affiliation":[{"name":"School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maricel R.","family":"Ribo","sequence":"additional","affiliation":[{"name":"San Lazaro Hospital, Manila, Philippines;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rontgene M.","family":"Solante","sequence":"additional","affiliation":[{"name":"San Lazaro Hospital, Manila, Philippines;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexis Q.","family":"Dimapilis","sequence":"additional","affiliation":[{"name":"San Lazaro Hospital, Manila, Philippines;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth O.","family":"Telan","sequence":"additional","affiliation":[{"name":"San Lazaro Hospital, Manila, Philippines;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Winston S.","family":"Go","sequence":"additional","affiliation":[{"name":"San Lazaro Hospital, Manila, Philippines;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Motoi","family":"Suzuki","sequence":"additional","affiliation":[{"name":"Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Koya","family":"Ariyoshi","sequence":"additional","affiliation":[{"name":"Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan;"},{"name":"School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher M.","family":"Parry","sequence":"additional","affiliation":[{"name":"School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan;"},{"name":"Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2795","reference":[{"key":"b1","author":"WHO","year":"2014"},{"key":"b2","series-title":"Lancet Infect Dis","first-page":"481","article-title":"Antimicrobial resistance in developing countries. Part I: recent trends and current status","volume":"5","author":"Okeke","year":"2005"},{"key":"b3","series-title":"Lancet Infect Dis","first-page":"568","article-title":"Antimicrobial resistance in developing countries. Part II: strategies for containment","volume":"5","author":"Okeke","year":"2005"},{"key":"b4","series-title":"Infect Control Hosp Epidemiol","first-page":"1099","article-title":"Outcomes of carbapenem-resistant Klebsiella pneumoniae infection and the impact of antimicrobial and adjunctive therapies","volume":"29","author":"Patel","year":"2008"},{"key":"b5","series-title":"Clin Infect Dis","first-page":"1026","article-title":"Bacteremia due to Acinetobacter baumannii: epidemiology, clinical findings, and prognostic features","volume":"22","author":"Cisneros","year":"1996"},{"key":"b6","series-title":"J Antimicrob Chemother","first-page":"125","article-title":"Antibiotic dispensing by drug store personnel in Bangkok, Thailand","volume":"21","author":"Thamlikitkul","year":"1988"},{"key":"b7","series-title":"Clin Infect Dis","first-page":"S142","article-title":"Antibiotic resistance: consequences of inaction","volume":"33","author":"Levy","year":"2001"},{"key":"b8","series-title":"J Clin Epidemiol","first-page":"61","article-title":"Purchase of antibiotics without prescription in Manila, the Philippines. Inappropriate choices and doses","volume":"43","author":"Lansang","year":"1990"},{"key":"b9","author":"WHO","year":"2014"},{"key":"b10","series-title":"Am J Respir Crit Care Med","first-page":"342","article-title":"Predicting bacteremia in patients with community-acquired pneumonia","volume":"169","author":"Metersky","year":"2004"},{"key":"b11","series-title":"Clin Infect Dis","first-page":"S368","article-title":"The effect of antibiotic exposure and specimen volume on the detection of bacterial pathogens in children with pneumonia","volume":"64","author":"Driscoll","year":"2017"},{"key":"b12","series-title":"Am J Trop Med Hyg","first-page":"397","article-title":"Reliability of parental history of antibiotic use for Filipino children admitted with acute lower respiratory tract infection","volume":"60","author":"Sombrero","year":"1999"},{"key":"b13","series-title":"Clin Infect Dis","first-page":"S159","article-title":"Disk diffusion bioassays for the detection of antibiotic activity in body fluids: applications for the pneumonia etiology research for child health project","volume":"54","author":"Driscoll","year":"2012"},{"key":"b14","series-title":"J Formos Med Assoc","first-page":"464","article-title":"Microbiologic assay for detection of antimicrobial agents in urine","volume":"95","author":"Wu","year":"1996"},{"key":"b15","series-title":"Trop Med Int Health","first-page":"24","article-title":"Urinary antibiotic activity in paediatric patients attending an outpatient department in north-western Cambodia","volume":"20","author":"Emary","year":"2015"},{"key":"b16","series-title":"Am J Trop Med Hyg","first-page":"295","article-title":"Urine antibiotic activity in patients presenting to hospitals in Laos: implications for worsening antibiotic resistance","volume":"85","author":"Khennavong","year":"2011"},{"key":"b17","series-title":"Am J Trop Med Hyg","first-page":"670","article-title":"The etiology of febrile illness in adults presenting to Patan Hospital in Kathmandu, Nepal","volume":"70","author":"Murdoch","year":"2004"},{"key":"b18","series-title":"Lancet","first-page":"1360","article-title":"Extent of antibiotic use in Taiwan shown by antimicrobial activity in urine","volume":"354","author":"Liu","year":"1999"},{"key":"b19","author":"The World Bank","year":"2016"},{"key":"b20","series-title":"J Antimicrob Chemother","first-page":"835","article-title":"An association between socioeconomic deprivation and primary care antibiotic prescribing in Scotland","volume":"69","author":"Covvey","year":"2014"},{"key":"b21","series-title":"BMJ","first-page":"h6117","article-title":"Antibiotic prescribing is higher in deprived areas of England","volume":"351","author":"Wise","year":"2015"},{"key":"b22","series-title":"BMC Infect Dis","first-page":"137","article-title":"Community acquired bacteremia in young children from Central Nigeria\u2014a pilot study","volume":"11","author":"Obaro","year":"2011"},{"key":"b23","series-title":"Hippokratia","first-page":"217","article-title":"Evaluation of use of antibiotics without prescription among young adults in Albania case study: Tirana and Fier district","volume":"18","author":"Jorgji","year":"2014"},{"key":"b24","series-title":"Lancet","first-page":"1225","article-title":"Aetiology, outcome, and risk factors for mortality among adults with acute pneumonia in Kenya","volume":"355","author":"Scott","year":"2000"},{"key":"b25","series-title":"Rev Infect Dis","first-page":"S998","article-title":"Comparison between parental report and results of microbiologic agar assay for presence of antibiotic in urine of Argentinian children with acute lower respiratory tract infection","volume":"12","author":"Catalano","year":"1990"},{"key":"b26","series-title":"Rev Infect Dis","first-page":"S907","article-title":"Diagnoses of acute lower respiratory tract infections in children in Rawalpindi and Islamabad, Pakistan","volume":"12","author":"Ghafoor","year":"1990"},{"key":"b27","series-title":"Rev Infect Dis","first-page":"S915","article-title":"Microbial agents associated with pneumonia in children from Uruguay","volume":"12","author":"Hortal","year":"1990"},{"key":"b28","series-title":"Rev Infect Dis","first-page":"S929","article-title":"Etiology of acute lower respiratory tract infection in children from Alabang, Metro Manila","volume":"12","author":"Tupasi","year":"1990"},{"key":"b29","series-title":"New Microbiol","first-page":"137","article-title":"Antimicrobial activity in urine: effect on leukocyte count and bacterial culture results","volume":"24","author":"Abu Shaqra","year":"2001"},{"key":"b30","series-title":"Am J Trop Med Hyg","first-page":"301","article-title":"Antibiotic use in Thailand: quantifying impact on blood culture yield and estimates of pneumococcal bacteremia incidence","volume":"83","author":"Rhodes","year":"2010"},{"key":"b31","series-title":"N Engl J Med","first-page":"39","article-title":"Bacteremia among children admitted to a rural hospital in Kenya","volume":"352","author":"Berkley","year":"2005"},{"key":"b32","series-title":"J Clin Epidemiol","first-page":"539","article-title":"Detection of antimicrobial activity in urine for epidemiologic studies of antibiotic use","volume":"52","author":"Liu","year":"1999"},{"key":"b33","series-title":"Clin Infect Dis","first-page":"S49","article-title":"Enhanced diagnosis of pneumococcal meningitis with use of the Binax NOW immunochromatographic test of Streptococcus pneumoniae antigen: a multisite study","volume":"48","author":"Mo\u00efsi","year":"2009"},{"key":"b34","author":"WHO","year":"2009"}],"container-title":["The American Journal of Tropical Medicine and Hygiene"],"original-title":[],"link":[{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/98\/5\/article-p1512.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/98\/5\/article-p1512.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/98\/5\/article-p1512.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,7,31]],"date-time":"2024-07-31T17:09:02Z","timestamp":1722445742000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/98\/5\/article-p1512.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,5,9]]},"references-count":34,"journal-issue":{"issue":"5"},"URL":"https:\/\/doi.org\/10.4269\/ajtmh.17-0564","relation":{},"ISSN":["0002-9637","1476-1645"],"issn-type":[{"value":"0002-9637","type":"print"},{"value":"1476-1645","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,5,9]]}}}