“Stop referring to a coming post-antibiotic era — it’s already here.”- This statement was made by the US Centre for Disease Control and Prevention Report (2019) almost within a century of the invention of the first antibiotic by Sir Alexander Flemming. Now, globally, Antimicrobial Resistance (AMR) is the 3rd leading cause of death. In 2019, about 4.95 million premature deaths occurred due to AMR which was higher than HIV/AIDS or malaria and this could rise to more than 10 million by 2050. 

Bangladesh also cannot escape the AMR threat. In 2019, about 26,200 deaths were attributed to AMR, and 98,000 deaths were directly related to AMR. Among 204 countries, Bangladesh was ranked 75 according to the age-standardized mortality rate affiliated with AMR per 1,00,000, which is alarming and needs proper action to control. 

What is AMR?

Antimicrobial Resistance (AMR) is a condition where microbes, bacteria, and viruses evolve in such a way that the drugs that were previously used against them are no longer effective, thus leading to serious illness and in some cases death. 

AMR is now a global concern that almost all countries including Bangladesh are suffering from. And, there is a heavy burden on the Sub-Saharan African countries. However, there is inadequate data regarding AMR-related fatalities in low-income countries. 

Read more: Edible oil in drums poses a threat to public health: PROGGA

Misuse or overuse of the antimicrobials is a significant driver of resistance. If the treatment is too long or short or incorrect, this increases the chance of antimicrobials becoming resistant. If this occurs then it creates more opportunities for microbes to develop and multiply.

AMR scenario in Bangladesh

AMR is a serious public health concern as Bangladesh has a decentralized healthcare system. In Bangladesh, most healthcare facilities are concentrated in secondary and tertiary hospitals. 

Besides these, the domestic pharmaceutical industries are now providing 97% of the countries’ medicine. Privately owned pharmacies and dispensaries resulted in easy access to the drugs. According to a  CAPTURA report in collaboration with UK Aid, uncontrolled pharmacies in Bangladesh resulted in possible misuse of antibiotics. It is estimated that almost 50.9% of the total antibiotics were purchased without prescription, which is an alarming situation. The number of AMR deaths in Bangladesh is higher than deaths caused by diseases like chronic respiratory diseases, tuberculosis, respiratory infections, diabetes, kidney diseases, and digestive diseases. 

Read more: Infections cause 20-40% of newborn deaths in Bangladesh: Study

Due to the decentralised healthcare system, AMR surveillance in Bangladesh is difficult to monitor. To prevent this situation from worsening, the government should take steps for monitoring in collaboration with the research centres like icddr,b, IEDCR, and different NGOs working on the healthcare facilities. Furthermore, international organisations like WHO, US-CDC, FFCGB, and USAID need to play crucial roles in controlling the situation.

Analysis of the policy issue

According to a WHO report, Southeast Asian countries have the highest risk of AMR among all the WHO regions. Bangladesh is no exception to this. In Bangladesh, antimicrobials are widely available as over-the-counter drugs. 

This situation became more complicated due to the presence of unqualified providers in the informal sector along with unethical marketing practices of the pharmaceutical companies. Besides human health hazards, the AMR has a drastic impact on the animals and the environment too (National Library of Medicine, n.d.). 

Impacts on human health

A recent research in Dhaka showed that in the case of Urinary Tract Infection (UTI), the most used antibiotics like Amoxicillin (82%), Azithromycin (75%), and Cefixime (64.5%) were found resistant among 1308 samples used. 

Read more: HMPV Virus Outbreak: Causes, Symptoms, Treatment and Prevention

Another newspaper report shows that almost 18% of bacteria isolated from children affected with pneumonia were resistant to all routinely used antibiotics like ampicillin, gentamicin, ciprofloxacin, and ceftriaxone. The report also showed that the frequent use of antibiotics to treat general colds, flu, and mild diarrheal illness is mostly responsible for fueling the AMR in the community. 

It has been observed that almost all age groups are more or less resistant to antibiotics but the children and youth are mostly affected by its effect.

Economic impact

In 2019, the World Bank found that the impact of AMR is also negatively affecting the world economy. The report estimated that by 2050, unchecked AMR would reduce the world GDP by 3.8% and push 28 million people into poverty. As a developing country, Bangladesh will also be a sufferer of this problem as due to AMR, people are now spending more on healthcare compared to other spending. 

A recent analysis showed that unaddressed AMR on livestock would cost global GDP up 

to $950 billion and its spread from livestock to humans would cost up to $5.2 trillion of world GDP (World Health Organisation, 2024).

Read more: Read more: Should You Drink Hot or Cold Water?

Environmental impact

Multi-drug-resistant bacteria have already affected the ecology of Bangladesh. Common resistant phenotypes included common antibiotics like Ampicillin, Tetracycline, Aztreonam, Nalidixic acid, and Ciprofloxacin. 

How does this issue affect different groups of people?

According to a report by Medical News Today, the most affected group by AMR is children under 5 years with pneumonia. Almost 18% of the total isolated bacteria are resistant to all routinely used antibiotics. 

The unsafe drinking water and poor sanitation are responsible for some common diseases which creates the demand for the widespread availability of over-the-counter antibiotics from the local pharmacies. Besides this misconception about antibiotics, weak surveillance processes, and less awareness among the sellers and patients are continually contributing to the growing AMR according to a report by the Dhaka Tribune. The irrational use of antibiotics in animal feed like poultry farms, and defective water management in the city are also spreading AMR among city people. 

Read more: How to Fix Your Sleep Routine: Know the Do's and Don'ts

A report by the Business Standard shows that 8 of the 12 antibiotics used in poultry farms were ineffective by at least 40% against the most common bacteria like E.coli. 

Comparative analysis

Different countries around the world are taking different approaches to tackle the situation like the One Health approach, Surveillance, Stewardship, awareness building, and agricultural steps. 

USA

The USA has taken steps like strengthening national One Health surveillance efforts, assuring advanced and innovative diagnostic tests, running an Antimicrobial stewardship program and national awareness week, promoting improved international collaboration to slow down the AMR among the people, etc. Besides, the US Government enforced the FDA regulations to restrict antibiotics in animal feeds.

These initiatives resulted in a 15% reduction in overall antibiotic prescriptions in the last decade. However, resistance persists due to continuous overuse of antibiotics in outpatient care and agricultural misuse. 

Read more: Effective Home Remedies to Combat Bad Breath

UK

The UK has taken the National Action Plan focusing on the One Health approach, assuring strict regulation, and public campaigns named “Keep Antibiotics Working”. These measures helped to reduce 23% of human antibiotic consumption between 2014 and 2020. In recent years, the UK has undertaken a long-term plan“Confronting AMR 2024 to 2029.” However, in the case of rural areas, this problem is still prominent. 

India

India initiated the National Action Plan in 2017 to address this issue. Besides this, they started surveillance through the Indian Council of Medical Research. These resulted positively in creating awareness against AMR. However, inadequate data was found regarding the use of antibiotics in the agricultural sectors.

Bangladesh

Bangladesh also initiated a national action plan to improve surveillance along with the One Health approach and stewardship. Besides this, different surveillance units are active in different hospitals to combat the situation. Public awareness has been created but is limited. Weak enforcement of regulations of antibiotics, the profit-maximizing attitude of pharmaceutical companies, and unregulated pharmacies lead to the persistence of the AMR situation.

Read more: Colon Cancer: Everything You Need to Know

Key lessons for Bangladesh

The developed countries exhibited a long-term plan to slow down the AMR problems. Furthermore, they are successful in reducing the percentage of AMR to a great extent. They are now working on surveillance and creating public awareness in curbing the effects of the AMR. Moreover, the developed countries are taking action to reduce the effect on the agricultural sectors which Bangladesh lacks. 

Proposed solutions and reforms  

Bangladesh needs to take both short-term and long-term plans to curb the effect of AMR. Here are some proposed solutions:

- Introducing DHIS2 for every patient so that the diseases and prescriptions are documented and developed in such a way that if antibiotics are prescribed then signals will be sent to professionals. This will help to review the necessity of antibiotics.
- Pharmaceutical companies should be properly regulated so that they cannot put pressure on doctors to prescribe unnecessary antimicrobials.
- Public awareness should be created from the root level. The concept of AMR and its dreadful effect can be included in the national curricula.
- The authorities may take initiatives to regulate the pharmacies and take the selling of antibiotics under surveillance. This will help the authorities to track the record of selling antibiotics.
- Traditional methods of treatment like Unani, Ayurvedic medicines, and Homeopathy need to be revived by doing research.
- The private sector in collaboration with NGOs may take initiatives to raise awareness among the rural people.
- The international development partners need to collaborate with the government for funding and propose policies that are effective in different countries.
- Doctors along with pharmacists should be properly trained about the AMR effects.
- Mobile health courts may be established to regulate the local pharmacies. 
- The farmers need training and proper awareness should be created to control the use of antibiotics in the agricultural and livestock sectors.
- The tannery industries should be taken under surveillance to reduce water pollution which is responsible for evolving germs in different ways.

Read more: Why You Should Try Walking Backwards

Conclusion

In the 21st century, Antimicrobial Resistance (AMR) is a global concern, and Bangladesh is at high risk. Proper actions and reforms in the healthcare sector may control the situation. In this case, proper steps should be taken by the government in collaboration with the private sectors, like NGOs, development partners, doctors, and pharmaceutical companies. And, most importantly, the mass population of the country should stand against the AMR effects. Otherwise, it would result in health hazards, economic problems, and environmental concerns to a greater extent.