REVIEW article
Front. Microbiol.
Sec. Antimicrobials, Resistance and Chemotherapy
This article is part of the Research TopicOne Health Approach for Tackling Antimicrobial Resistance in Diverse EcosystemsView all 8 articles
Antibiotic Resistance in the Philippines: Environmental Reservoirs, Spillovers, and One-Health Research Gaps Across One Health (A Narrative Review)
Provisionally accepted
- 1Manila Central University, Caloocan, Philippines
- 2National Environment Agency, Singapore, Singapore
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Antimicrobial resistance (AMR) remains a major health threat in the Philippines, where high antimicrobial use, intensive aquaculture, and recurrent typhoon-driven flooding and monsoon seasons shape distinctive transmission pathways. This narrative review synthesizes published Philippine data across clinical, agriculture, and environmental sectors to map evidence and gaps relevant to policy. Clinically, vancomycin resistant Enterococcus faecium is 23%, Klebsiella pneumonia shows ~15% carbapenem resistance, and Escherichia coli resistance to third generation cephalosporins (3GC) and fluoroquinolone are ~43% and ~46% respectively. In food animals, ceftriaxone resistance in non-typhoidal Salmonella (NTS) increased from ~8% (2010) to ~43% (2020s), with ciprofloxacin resistance between 14-23%. Environmental studies report extended spectrum beta-lactamase (ESBL)-producing E. coli in Manila estuaries and multiple antibiotic resistance (MAR) indices of up to 0.15 in tributaries. Hospital sewage and nearby rivers have yielded carbapenemase-producing Enterobacterales (CPE) bearing blaNDM/blaKPC in clinically relevant lineages (e.g., E. coli CC10, K. pneumoniae ST147). Cross sector comparisons remain constrained by method heterogeneity and data gaps. To operationalize One-Health monitoring, we propose (i) a two window surveillance design: late dry baseline and 24-72h post-storm flood pulses; and (ii) a two tier analytics model: Tier 1 HT-qPCR ARG/MGE panels at regional hubs for rapid screening, and Tier 2 metagenomics/isolate whole genome sequencing (WGS) at national hubs for source attribution and plasmid tracking. We translate these findings into a modular AMR risk assessment toolkit to prioritize surveillance and targeted interventions.
Keywords: Antimicrobial resistance (AMR), One Health, Hospitals, Wastewatertreatment plants (WWTP), Environmental waters, foodagriculture, Sewage
Received: 23 Sep 2025; Accepted: 14 Nov 2025.
Copyright: © 2025 Ng, Abrazaldo, de Vera, Goh and Tan. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Charmaine Ng, cmng@mcu.edu.ph
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