@article{oai:nagasaki-u.repo.nii.ac.jp:00001930,
 author = {Saito, Nobuo and Takamura, Noriko and Retuerma, Grace P. and Frayco, Carina H. and Solano, Paul S. and Ubas, Cherlyn D. and Lintag, Arianne V. and Ribo, Maricel R. and Solante, Rontgene M. and Dimapilis, Alexis Q. and Telan, Elizabeth O. and Go, Winston S. and Suzuki, Motoi and Ariyoshi, Koya and Parry, Christopher M.},
 issue = {5},
 journal = {The American Journal of Tropical Medicine and Hygiene},
 month = {May},
 note = {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.Aurine sample was collected and a bioassay was used to
detect antibiotic activity in urine using Bacillus stearothermophilus (ATCC7953), Escherichia coli (ATCC25922), and
Streptococcus pyogenes (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?23) years and 158 (39%) reported prior antibiotic use, predominantly a beta-lactam antibiotic. A total of 164 (40%,95%
confidence interval [CI]: 35?45) patients were urine bioassay positive with any of three organisms. The Bacillus assay was
the most sensitive, detecting 162 (99%, 95%CI: 96?100) cases. Among bioassay positive patients, dengue (N= 91, 55%,95% CI: 48?63) was the most frequent diagnosis, followed by other viral infections, including measles, rubella, and mumps (N= 17, 10%,95%CI: 6?16). Patients with a positive bioassay were significantly more likely to be from the lowestincome group (adjusted odds ratio [AOR]: 1.7; 95% CI: 1.1?2.6) and required hospital admission (AOR: 2.1; 95% CI:
1.3?3.5). 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., The American journal of tropical medicine and hygiene, 98(5), pp.1512-1519; 2018},
 pages = {1512--1519},
 title = {Frequent Community Use of Antibiotics among a Low-Economic Status Population in Manila, the Philippines: A Prospective Assessment Using a Urine Antibiotic Bioassay},
 volume = {98},
 year = {2018}
}