Antibiotic was working as magic bullet against infection causing bacteria since discovery in 1928. By evolution, some bacteria fight back against antibiotic and become resistant. In 21st century, antimicrobial resistance is one of the biggest threats for the world. All over the world, antibiotic resistant bacteria infect a huge number of people and cause death of a certain number of them. Due to resistance to antibiotics, it is very tough to treat these infections. Abuse of antibiotics is proved a leading cause of forming resistance and there are lots of severe cases reported due to antibiotic resistance for respiratory infections. Resistance can occur by mutation in gene to alter target protein, change membrane permeability etc. or by acquiring resistant gene from different bacterium. These genes can be carried by plasmid or bacterial chromosome. Chromosomal resistant genes generally transfer mother to daughter by vertical transmission, can also be transferred horizontally by conjugation. But plasmid can be transferred other surrounding cells as well as daughter cells. By horizontal transfer, resistant gene can be transferred to a bacterium of a different species. Moreover, poultry and animal farmers use antibiotics for better production which eventually enter into human body through food chain. There is no circumspection to control the market of medicines. So, it has become mandatory to control purchase of drugs and make people aware of antibiotic resistance to ameliorate the situation.
Antibiotic Resistance in Bangladesh
Here I have collected data from various research studies to realize: 1) which antibiotics are used mostly in our country in various diseases; 2) in which cases antibiotics are used, and 3) the situation of antibiotic resistance in our country.
A survey on antibiotics practices in Chittagong conducted by IIUC in 2015 revealed that antibiotics were prescribed for 69.49% of patients and azithromycin (30.49%), cefixime and ciprofloxacin are widely used. Staphylococcus aureus and Staphylococcus pneumoniae are proved to be liable for acute respiratory tract infection in our country by a study conducted by GARP (Global Antibiotic Resistant Partnership)-Bangladesh and CDDEP along with icddr,b. Samples taking from Enam medical college during 2014-2015 period showed that these two pathogens are largely resistant to amoxicillin and cotrimoxazole. Another research of icddr,b shows that rotavirus and E.coli, 2 major pathogens for diarrhea are resistant to TMP-STX and erythromycin, nalidixic acid respectively.
Causes of Antibiotic Misuse in Bangladesh
There are many reasons for misuse of antibiotics in our country:
- Many people buy antibiotics from medicine shops without prescription. Most of them don’t complete the course and treat themselves with antibiotics by their previous experience.
- People think antibiotics can recover them from any disease quicker than other drugs.
- Many rural people are dependent upon village doctors. They recommend high dose of antibiotics at the early stages of the disease. According to a survey from 10 villages in 2019 conducted by ABACUS (Antibiotic Access and Use) project in Matlab, villagers generally don’t take facilities of doctors and pharmacies from district medical colleges due structural corruption, stock out, etc. They buy antibiotics from rural pharmacies at low price motivated by family members and are reluctant to know the harmful effects.
- Here the prices of antibiotics are much less than abroad.
- Rural pharmacies were the preferred and trusted source of antibiotics for self-treatment.
- People don’t know which drugs are antibiotics and also don’t finish the course. Around 1.5 million people are taking antibiotics daily without prescriptions.
- Antibiotics are used at random in meat and milk production to increase yield. Farmers have a wrong notion that more antibiotic, more production. Those antibiotics enter our body through consumption. This sub-lethal level of antibiotic triggers bacteria to create mutation on multiple regions of the chromosome and causes multiple antibiotic resistance. According to the Daily Star, a study conducted by Bangladesh Agricultural Research Council (BARC) and Patuakhali Science and Technology University showed that nearly 50% of poultry feed of 14 brands contain antibiotics.
Possible Solutions to Overcome Antibiotic Misuse in Bangladesh
We should follow some steps through both social activities and law enforcement:
- Doctors should advice people not to take antibiotics for silly sickness. Besides pharmacy owners should be punished under National Drug Policy-2005 and other laws if they sell antibiotics without checking prescription.
- In 90s, BTV and other electronic media broadcast TVCs on HIV and tuberculosis that created a huge impact on making awareness. Now we can also make and broadcast TVCs to promote awareness on antibiotic resistance.
- We can celebrate World Antibiotic Resistance Awareness Week in educational institutions specially in schools.
- People of rural areas should be encouraged to follow hygiene instead of using antibiotics indiscriminately for diarrheal diseases.
In our country, acute respiratory tract diseases and diarrheal diseases cause lots of deaths. At present antibiotic resistance has become an alarming problem for people suffering from lower respiratory tract infection and so on. It is high time we made people conscious of the consequences of misuse of antibiotics. It will lead to the lessen of preventable death caused by infectious diseases which is one of the targets of SDG Goal 3.