Rakib Hasnat bought a drug of the Metronidazole group for his loose motion from a pharmacy in the Dhanmondi area. The brand name of this drug is a household name in Bangladesh. But like many, Rakib is also unaware that it is an antibiotic.
“I take it when I feel any abdominal problem, diarrhoea. I feel better after taking this drug,” he told Dhaka Tribune while buying this medicine from a pharmacy in the Shankar area.
The drug seller is also nonchalant. He is unaware that the government has recently passed a law banning antibiotic sales without prescriptions. Dhaka Tribune does not mention the name of that particular pharmacy since it is a common practice in Bangladesh. Anyone can buy any drug over the counter.
“We have no idea about the law,” the shopkeeper said when asked. The law has a provision for a fine of Tk20,000 for selling antibiotics without a prescription.
“But the question is how to enforce the law. There is no mechanism to do that. When there is public demand, then the local drug shop cannot prevent them,” Professor Dr Md Sayedur Rahman of the Pharmacology Department of Bangabandhu Sheikh Mujib Medical University told Dhaka Tribune.
“Everyone from doctors to drug shops to general people needs to be aware of the use of antibiotics,” he said on Thursday, as the week-long World Antimicrobial Resistance (AMR) Awareness Week ends on Friday.
Experts say such rampant use of antibiotics is actually inviting drug resistance.
According to the World Health Organization, AMR occurs when bacteria, viruses, fungi, and parasites no longer respond to the active ingredients, or antimicrobial agents, in medicines used to treat them. When antibiotics, which are used to treat bacterial infections, and other antimicrobial agents become ineffective, infections become difficult or impossible to treat, increasing the risk of disease spread, severe illness, and death.
AMR contributes to almost five million human deaths from bacterial infections alone each year. This, coupled with the poor state of research and development investment into new antimicrobials, has led WHO to highlight AMR as one of the top 10 global public health threats facing humanity.
The main driver of AMR, which threatens humans, animals, plants, and the environment, is the misuse and overuse of antimicrobials, both for human health and in food production, WHO says.
Bangladesh has strategies to combat this menace. However, implementation remains a challenge.
Doctors prescribe Metronidazole as a strong antibiotic to treat a wide variety of infections. It works by stopping the growth of certain bacteria and parasites. It will not work for viral infections. Most of the diarrhoea in Bangladesh is caused by viral infections.
“We did research many years ago in which we found that if we can train doctors and drug shop owners, then 6% of misuse can be reduced. If we can make the general public aware, then 12% of misuse can be reduced. But if we can make school students aware of antibiotic use, then 32% misuse would be reduced,” Prof Sayedur Rahman said.
“Considering that we have been pushing the government for a long time to introduce the issue in the school textbook. This year, the government has decided to introduce this in the curriculum gradually, starting in sixth grade,” he said.
Prof Mahmudur Rahman, former director of the government’s disease monitoring agency, IEDCR, and one of the founders of One Health Bangladesh, told Dhaka Tribune that this is also a big challenge when it comes to animal health.
“Antibiotics are being used as growth promoters for livestock. And this eventually affects human health after coming through the food chain,” he said, suggesting concerted efforts.
“We have a surveillance system in the IEDCR for human health and the Department of Livestock for animal health. We need to strengthen those surveillance mechanisms and, at the same time, take action following the evidence.”
“Another challenge is that we have many pharmacies that are not registered with the government. So, if you start monitoring them, you can only do that in registered shops. So, awareness build-up is the key. Even after doctors’ prescriptions, due to socio-economic reality, many people do not complete the full course after feeling better. Antibiotics are costly. So, you will find many people will take antibiotics for the first three or four days and then stop, instead of completing the course for five or seven days or more. Government hospitals also do not give the full course at a time while distributing antibiotics to prevent pilferage,” he said.
“We need to work with the drug makers also. If the government can bring them on board in this fight, then we can better manage the situation by tracking where the antibiotics are being sold.”
“One of the challenges in addressing antimicrobial resistance, or AMR, is that it is a very medicalized term. We need to unpack it, break it down, and communicate it effectively to people around us,” Philip Mathew, WHO’s Technical Officer on AMR, said in an international webinar.
“Another challenge is that there is no uniform communication on AMR, as some refer to antimicrobial resistance while others to antibiotic resistance. Translating AMR into local vernacular languages further ups the challenge. If we look at the drivers of AMR in several sectors, the impact is also multi-sectoral," he said.
“Misuse of antimicrobials happens in human health, animal health, food and agriculture, and several other sectors. While communicating about AMR to common people, we should frame it as an issue in which medicines have stopped working for infections that they are meant to treat. So, people are suffering or untimely dying because even simple infections are becoming very difficult to treat.”