Filipinos have great confidence in the effectiveness of antibiotics against infection and disease. Antibiotics have literally saved the world on more than one occasion, but they still require correct usage in order to do their work. They’re not magic pills that will miraculously make you better: they are medicines that need to be taken in the proper dose, for the correct amount of time.
There are consequences to non-compliance with antibiotic prescriptions, and one particularly worrisome result is Antimicrobial Resistance (AMR). Simply put, infections that should respond to antibiotics, but no longer do. What are the causes of AMR?
“One of the causes is non-compliance with medication,” Dr. Rontgene Solante, current president of the Philippine Society for Microbiology and Infectious Diseases. “Among Asian countries the Philippines has this problem because we usually buy antibiotics over the counter, and most of the time we only take these for two or three days. When the symptoms are relieved, we stop taking the antibiotics.”
Everyone who’s done this, raise your hands.
“The problem there,” Dr. Solante continues, “is that you may be able to treat that particular infection, but what happens when you have a second, third, or fourth infection? The severity of the second or third infection will depend on the immunity of the patient, the organism he acquired, and whether this is a more resistant organism.
“For instance you have a respiratory tract infection this month and then a month later you have another respiratory tract infection. The infection may be caused by the same organism, but that doesn’t always mean that your response to the same antibiotic will be the same.”
Another unfortunate habit: Using meds left over from previous illnesses. “This is so common among Filipinos,” the doctor says. “You have a cough so the doctor prescribes amoxicillin. The next time you have a cough you don’t see a doctor; you go straight to the drugstore and buy amoxicillin with the old prescription.
“That’s not a problem because amoxicillin can treat your cough. Eighty percent of the time it’s the same organism causing it, usually streptococcus. The problem there is if the organism is not the same as the one as in your earlier cough.” In which case the antibiotic will not help you.
“Here’s an actual patient,” Dr. Solante recalls. “A five-day course of antibiotics was prescribed for his respiratory infection. He felt better after three days, so he stopped taking the antibiotics and then he saved the remaining dosage for the next time he had a cough. He thinks it’s saving.”
By being too casual about following prescriptions, or by economizing (“I’m already cured, I don’t need to finish the dose so I’ll just save my money.”), we put our own future health at risk. If you habitually ignore doctors’ instructions, a time may come when the antibiotics you need to treat an illness will no longer work for you.
“That is always the problem,” Dr. Solante notes. “Matigas ang ulo nating mga Pilipino. Even if we educate the people, the problem is economic. For most patients, even if you emphasize the importance of taking the medicine for five days and finishing the dose, most of them will not.”
As an example Dr. Solante cites the rise in the number of cases of multi-drug resistant tuberculosis. Patients with TB usually buy their medicines out of pocket, and the treatment takes six months. Many if not most of those patients will not complete the course of the treatment for a variety of reasons, primarily the cost. “That’s why the government is now shouldering the cost of TB treatment,” Dr. Solante says.
“Going back to AMR, if you take a drug for three days instead of the five days that the doctor prescribed, that’s non-completion of treatment.
There may be recurrence of infection. It may disappear during the first episode, but it may recur. The recurrence may signify that the initial organism may not be totally eradicated because the dosage of antibiotic was incomplete.”
The problem of antimicrobial resistance (AMR) is common not only in the community but in the hospitals themselves, the doctor points out.
“The problem originates in hospitals because these are patients who have already received several antibiotics before they were admitted.
Most of these patients harbor organisms that are resistant to antibiotics at the outset.
“In the hospitals when you have an antimicrobial-resistant infection, it entails the use of more effective antibiotics. More expensive antibiotics will be required, and a longer stay in the hospital. The cost of hospitalization rises.”
It is more practical and less complicated to address the problem of AMR in the community rather than in the hospitals, Dr. Solante says.
“The organisms in the community are more susceptible to antibiotics compared to those organisms in the hospital.” The problem is that there are now infections in the community that are resistant to antibiotics. “For instance there are ordinary urinary tract infections which are supposed to respond to amoxicillin, but those infections are now resistant to amoxicillin and other antibiotics.”
According to the head of the Philippine Society for Microbiology and Infectious Diseases, there are several strategies for dealing with non-compliance with medication.
“One of the present strategies is to treat the infection in a single dose. For instance, the patient has pneumonia. There are now antibiotics that can be given in one dose. For urinary tract infections, studies said the patients had to be treated for seven to 10 days, but later studies say the treatment can be reduced to three days.
“The important thing is that the patient complies with the treatment. So that’s one strategy for improving compliance: shortening the course of the treatment.”
Another strategy is to make compliance easier, more convenient, and more economical to the general public. Pharex HealthCorp, the country’s leading brand of generic medicines, now offers easy compliance packages called Masunurin Value Packs or Pharex MVP. The company’s first-line antibiotics Amoxicillin, Cefalexin, Ciprofloxacin and Cloxacillin have been re-packaged in specially-designed foil packets that are more convenient for patients — and more affordable, too.
Pharex antibiotics are priced 25 to 50 percent lower than branded medicines, so patients can afford to buy the full dosage as prescribed.
Each Pharex MVP is a complete five-day treatment program for mild to moderate infections. Its innovative Zip-loc packaging preserves the quality of the antibiotics while making it more convenient for patients to carry their medications wherever they go.
Along with its Masunurin Value Packs, Pharex has launched the Masunurin Advocacy Program to educate the public on how to prevent antimicrobial resistance. With its simple but memorable slogan “Maging Masunurin,” Pharex is addressing the root cause of AMR: non-compliance.
“Pharex has always placed the well-being of the Filipino patient first and foremost. Our goal is to provide the best healthcare while making it affordable,” says Tomas Marcelo Agana III, president and CEO of Pharex HealthCorp.
For antibiotics to remain effective against disease, we need to use them properly. Don’t take chances with your future health: Maging Masunurin.