The culture of overusing antibiotics without proper medical supervision will threaten lives in Bangladesh in the near future, doctors and researchers have warned.
Antibiotics are sold without prescription everywhere, and people will take them for any common malady, even colds and viral fevers. This careless use of antibiotics, coupled with the common practice of dropping out of prescribed courses, is threatening to give rise to antibiotic-resistant infections. Researchers have called on the government to stop the misuse of antibiotics and for a ban on the sales of these drugs at pharmacies without prescription.
About four months ago, Mahbubur Rahman, 83, (name changed for privacy) died in a private hospital in Dhaka. Suffering from diabetes, high blood pressure and pneumonia, he could not be saved even after being admitted to the hospital. A month ago, Mukul Chandra Das, 67, (name changed for privacy) was admitted to a hospital after catching a fever in the rain. Diagnosed with pneumonia and a lung infection, he was first admitted to BIRDEM and then later transferred to the same private hospital. But no drugs would work on him, and doctors were unable to save him despite their best efforts.
Doctors said the two could not be saved because they were immuno-compromised and their infections had become antibiotic resistant.
The unregulated use of antibiotics for livestock, fish and agriculture have increased at alarming rates. Half of all antibiotics are used in agriculture, and their rampant use has led to an increase in kidney problems in consumers.
According to a study by the environmentalist group Poribesh Bachao Andolon, 55.7% of people in the capital have become resistant to antibiotics.
Because of the excessive and unnecessary use of these drugs, doctors believe that a system of regulation is urgently required. Several doctors told this correspondent they were seeing said the signs of an antibiotic resistance catastrophe as a result of their excessive use.
Even though there are no numbers on how many people die in Bangladesh because of antibiotic resistance, according to a report from the US, 23,000 Americans and 700,000 people worldwide die of this cause. If this trend continues, 10 million people worldwide will die because of ineffective drugs.
According to information from the World Health Organisation (WHO), drugs have become ineffective in treating the sexually transmitted disease, gonorrhea. If rampant use of antibiotics continue, soon gonorrhea might become untreatable.
Dr Sania Tahmina, director of disease control at the Directorate General of Health Services, said that antibiotic resistance will be the leading cause of death by 2050.
She told the Bangla Tribune: “Antibiotic resistance is a scary prospect. If we cannot stop the unnecessary use of these drugs, we are looking at a bleak future.”
ABM Faroque, professor at the Dhaka University's pharmaceutical technology department, told the Bangla Tribune: “There are specific guidelines on the use of antibiotics. If these rules are not followed, the body develops resistance. Using antibiotics at less than the prescribed amount, more than the prescribed amount, not finishing the entire regime, or using fake or low quality drugs are all possible causes of developing resistance.”
According to a research done at his department, antibiotics from the third generation cephalosporin group are the ones most prescribed by hospitals. The next few common groups are macrolide, second generation cephalosporin and penicillin.
The most heavily treated age group are children between one and four.
The research also showed that misuse of drugs was more prevalent for younger children. The misuse of these drugs led to longer hospital stays, more physical complications and higher death rates.
“If we are unable to stop the overuse of antibiotics, then at one point all the antibiotics in the world will become useless, and bacteria and disease will become rampant. That is why it is very important that we tackle this issue as soon as possible,” said preventive medicine specialist Dr Lelin Chowdhury.
Dr Sitesh Chandra Bashar, another professor of pharmacy at Dhaka University, called antibiotic resistance a serious medical and social issue for Bangladesh.
“Currently, we administer an antibiotic from the carbapenem group to patients in the ICU, when all other drugs have failed. But if patients somehow become resistant to carbapenem, then patients will die. It is a matter of grave concern that in some places people have started becoming resistant to carbapenem.”
He also said: “11 countries in Asia, including Bangladesh, are showing growing antibiotic resistance. This has become an impediment to carrying out surgeries, or treating cancer. WHO has compared the situation to the time before the discovery of antibiotics.”
Dr Abdur Rahim, chairman of the department of internal medicine at Bangabandhu Sheikh Mujib Medical University, said: “Antibiotics are not sold without prescriptions in developed countries. Here, we can just go into a pharmacy and get whatever we want.”
He said that quacks in rural areas were even keener on selling antibiotics than real physicians.
“They even prescribe drugs that we would not even dare to.”
When asked if he had seen any patients who were unable to treated because of antibiotic resistance, he said: “We have not reached that stage yet, but if we are not careful, it will not take us long to get there.”
Citing an example, he said: “Urine infection is a very common disease, but when we perform a culture test for the disease, we see that most antibiotics have no effect. It has become resistant to all drugs save one or two. We have to prevent this situation from getting worse, or even patients on their deathbeds will become untreatable.”