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New research on antimicrobial resistance in Bangladesh paints a bleak picture

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For more than a decade, pathogenic microorganisms are showing a growing trend of resistance to our arsenal of antibiotics. This is known as antimicrobial resistance or AMR. WHO identifies this as one of the top public health threats around the world.

AMR can increase deaths and disability, causing economic costs to rise sharply. A report published by the UN Ad hoc Interagency Coordinating Group on Antimicrobial Resistance in 2019 revealed that 0.7 million deaths globally could be attributed to AMR.

The projection showed that in 30 years, this number will be a whopping 50 million. At the same time, almost 24 million of the world’s population will be suffering from poverty as a consequence of AMR.

Study findings in Bangladesh

In Bangladesh, there were several small scale studies on AMR in this century, particularly in the last decade. But this issue just came to national attention with a surveillance programme established back in 2016.

Recently, the Directorate General of Health Services (DGHS), the Ministry of Health and Family Welfare of Bangladesh presented a report on their collaboration with the CAPTURE project (Capturing data on Antimicrobial resistance Patterns and Trends in Use in Regions of Asia).

The results announced by DGHS just state the obvious. Data collected using bacterial strains from 34 laboratories and 5 model pharmacies demonstrated a high prevalence of AMR.

The majority, 31-67 per cent of the strains are multi-drug resistant. This means not only common antibiotics are ineffective against them, but also several less used and highly powerful drugs as well.

The CAPTURE project also confirmed what is already common knowledge - widespread misuse of antibiotics. According to WHO standards, the use of these medicines should not be >40 per cent of the market, but the data we have revealed the usage to be 70-80 per cent in Bangladesh.

Acute knowledge gap

DGHS also conducted a survey on medicine retailers. Among 427 participants from 8 divisions, 67.3 per cent were shown to have inadequate knowledge of antibiotics. These are the people who dispense drugs and are often the first contact between patients and health care services.

The CAPTURE project is validating what other small scale studies found. Researchers from BRAC James P Grant School of Public Health conducted a systematic review of the AMR studies in our country. Their findings of indiscriminate use of antibiotics without prescription and consequence rise in resistance are one such example.

The data presented is also aligned with the results of the national antimicrobial resistance surveillance 2016-2020 by the Institute of Epidemiology, Disease Control & Research (IEDCR). The information showed a rapid rise in AMR with many strains becoming resistant to the reserve groups of antibiotics.

We can also link the CAPTURE report with another published in 2018 by GARP-Bangladesh and CDDEP. It showed more than half of the antibiotic use is irrational.

The researchers singled out several factors as important drivers of resistance, consistent with CAPTURE data. Some of these factors are - lack of proper consultation, under valuing proper diagnosis, expectation of quick relief on the side of the patients, and failure to complete course either due to financial reasons or disappearance of symptoms.

What government is doing

So how are we dealing with it nationally? There is an action plan currently being implemented. In addition DGDA also made some recommendations. They asked the pharmaceutical companies to mark the packaging of the antibiotics in red.

The Assistant Director of DGDA, SM Sabrina Yasmin said the manufacturers would need to add, within six months a red identification mark with the text 'Antibiotic' and a label that says  'Do not use without a prescription of a registered physician.'

Additionally, DGDA Director General informed that, for vendors selling antibiotics without prescription, a Tk 20,000 penalty would be imposed.

Many wonders, why don’t make new antibiotics. Well, that is not so easy; making completely new antibiotics is a long and arduous process, and currently, there is not much hope for that.

WHO currently lists only six such drugs as in the development stage, and who knows how long it will take for them to reach the market, considering they are able to get through the previous steps.  

Therefore, awareness is crucial to stop the irrational use of antibiotics, both by the physician as well as the patient.

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