Prevalence and correlates of antibiotic sharing in the Philippines: antibiotic misconceptions and community-level access to non-medical sources of antibiotics

Objective: To identify sociodemographic, knowledge and attitudinal correlates to antibiotic sharing among a community-based sample of adults (age 18 and older) in a low-income setting of the Philippines and to explore community-level data on informal antibiotic distribution in roadside stands (i.e., sari-sari stands). Methods: Participants (n = 307) completed self-administered surveys. Correlates to antibiotic sharing were assessed using logistic regression with Firth's bias-adjusted estimates. Study staff also visited 106 roadside stands and collected data on availability and characteristics of antibiotics in the stands. Results: 78% had shared antibiotics in their lifetime, most often with family members. In multivariable analysis, agreement with the belief that it is safe to prematurely stop an antibiotic course (OR: 2.8, CI: 1.3–5.8) and concerns about antibiotic side effects (OR: 2.1, CI: 1.1–4.4) were significantly associated with increased odds of reported antibiotic sharing. Antibiotic sharing was not associated with sociodemographic characteristics or antibiotic knowledge. Antibiotics were widely available in 60% of sampled sari-sari stands, in which 59% of antibiotics were missing expiration dates. Amoxicillin and cephalexin were the most commonly available antibiotics for sale at the stands (60% and 21%, respectively). Conclusions: Antibiotic sharing was common and was associated with misconceptions about proper antibiotic use. Antibiotics were widely available in sari-sari stands, and usually without expiration information. This study suggests that multipronged and locally tailored approaches to curbing informal antibiotic access are needed in the Philippines and similar Southeast-Asian countries.