Bacterial resistance to antibiotics: access, excess, and awareness in Bangladesh

ABSTRACT

Introduction: Antibiotic resistance is a substantial cause of mortality, morbidity burden in Bangladesh. In this perspective piece, the problem of antibiotic resistance has been analyzed by critically evaluating literature data, and based on the author’s experience.

Areas covered: The underlying causes of this resistance are numerous including irrational and inappropriate use of antibiotics aggravated by aggressive marketing, over-the-counter dispensing, prescribing by the unqualified providers, lack of awareness in the general population, and inadequate implementation of relevant regulations.

Expert opinion: Although Bangladesh is making some progress toward containing antibiotic resistance, the pace of this progress is insufficient. Public awareness is crucial for the full implementation of the regulations. Given that it is more a social than a medical problem, the health sector is unable to tackle the problem on its own. An integrated approach is required that identifies the roles and relative importance of each sector (human, animal, and environment). A set of recommendations has been provided for the government to act.

KEYWORDS:

• Antibiotics
• antibiotic resistance
• bangladesh
• public health
• regulation

Article highlights

• Bangladesh faces a substantial public health problem with regard to antibiotic resistance. Purchasing antibiotics without prescriptions from pharmacies and drug stores and discontinuing treatment before courses are completed are very common.

• The regular arrangement of geospatial surveillance of resistance patterns is urgently needed to intervene effectively to reduce antibiotic resistance.

• Regulatory and frontline machinery must be activated and provided so proportionate action can be taken on inappropriate prescriptions, dispensing, and uses of antibiotics.

• Improvements in drinking water, sanitation and hygiene, upgrades of diagnostic facilities, and educational drives can pave the way for proper implementation of the relevant policies and guidelines.

• Until qualified prescribers are available, an arrangement is needed in remote and rural areas to establish a balance between access to effective antibiotics and interventions to reduce unnecessary use.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.