The discovery of the first antibiotic by Alexander Fleming in 1928 revolutionized the therapy of infection and reduced mortality and morbidity from microbial disease.Antibiotic is the leading weapon in the treatment of bacterial infections. Currently, antibiotics are the most widely used category of drugs in the world. Despite enormous benefit of prudent use of antibiotics would have had on public health, the irrational use of these have driven the inexorable spreading out of resistant microbes leading to a loss of efficacy of these drugs. Eleven countries in Asia, including Bangladesh are showing an amplified trend of antibiotic resistance.Many physicians have already considered this situation as an impediment to carrying out surgery or treating cancers. There is no published report on how many people die in Bangladesh because of antibiotic resistance. But the global scenario is very alarming. According to a report from the USA, every year 23,000 people of America and 700,000 people of worldwide die of this cause. If this trend continues, every year 10 million people worldwide will die because of ineffective drugs. Antibiotic resistance is a serious medical and social issue and the World Health Organization (WHO) has compared the situation to the time before the discovery of antibiotics.
Self- medication has been cited as a major factor contributing to drug resistance, particularly with the use of antimicrobials. Self-medicated use of antibiotics is one of the most common ways in which antibiotics are misused. Inappropriate dispensing, irrational use of antibiotics owing to commercial interests and lack of awareness about the rational use of antibiotics are the foremost causes of antibiotic resistance.
Prescription-only medicines (POMs) which include antibiotics are not to be sold over the counter. Pharmacies are only licensed to dispense POMs against valid prescriptions. Many consumers in Bangladesh are not aware of this matter. Lack of consumers’ awareness and poor enforcement by the government and regulatory bodies allow pharmacies selling POMs as over the counter drugs (OTC). In recent times, pharmacists have been viewed as retailers and businessmen rather than health care providers. There are specific guidelines on the use of antibiotics which should be strictly followed by the physicians or pharmacists. Around 80% people of Bangladesh live in rural area, where there is a high prevalence of quack doctors, who are very desperate in selling and prescribing of antibiotics rather than real physicians. But consumers, have the right to be treated with antibiotics followed by the specific guidelines on the use of antibiotics. Using antibiotics at less than the prescribed dosage, more than the prescribed amount, not finishing the entire regime, or using fake or low quality drugs are all possible causes of developing resistance.
The unregulated use of antibiotics for livestock, fish and agriculture have increased at alarming rates. Antibiotic is a lifesaving drug and recommended by the registered doctor only to treat diseases. But unfortunately, antibiotics are being used injudiciously in prevention procedure or in feeds as growth promoter. Some antibiotics are not even recommended for food animals. A complete ban on antibiotic and steroid growth promoters in animal feeds have already been imposed by the governments of Bangladeshthrough Fish and Animal Feed Act-2010. But results from many researches revealed those residues of antibiotic are still present in poultry meat, eggs and cow milk. Vested interest, low veterinary regulation and poor enforcement of Act may be root causes of this situation. Unregulated use of antibiotics for livestock and fish also contribute substantially in antibiotic resistance catastrophe.
Stronger action is needed from all sectors to stop the misuse and overuse of antibiotics to combat the antibiotic resistance catastrophe. Only policies and high level commitment alone are not enough to stop the irrational use of antibiotics. Creating awareness among all stakeholders regarding danger of irrational use of antibiotics is very urgent to combat the situation. We must engage the consumers and make sure everyone knows how to use antibiotics responsibly. We should always follow health workers’ advice when using antibiotics and only use antibiotics when prescribed by a certified health professional. Pharmacy owner and pharmacist must stop selling of antibiotics without prescription. Rational use of antibiotics should be encouraged to limit the emerging antimicrobial resistance posed by indiscriminate use of antibiotics.
Md. Khalilur Rahman Sajal
Executive Director
Voluntary Consumers Training and Awareness Society (VOCTA)
E-mail: sajal.voctabangladesh@gmail.com