The danger of antibiotic resistance

The invention of antibiotics was a milestone in the history of modern medicine and those were hailed as miracle drugs for their ability to prevent infections. These lifesaving drugs are now losing their effectiveness globally, much to the concern of health experts. The situation is particularly alarming in Bangladesh. A recent World Health Organization (WHO) report has revealed a shocking truth --- several of the commonly used antibiotics in the country have lost up to 97 per cent of their efficacy. Why is it happening? There are many reasons behind it -- unregulated sales, over-prescription, self-medication by patients and incomplete dosages.

According to media reports, physicians are finding that once-reliable antibiotics are not working the way they are supposed to. Infections which were easily treatable a decade ago now linger on or recur, compelling physicians to increase doses or change drug brands.

 This phenomenon, technically called antimicrobial resistance, threatens to undermine the very foundation of healthcare. Let alone major surgeries, childbirth and even minor infections can become life-threatening if antibiotics do not work properly.

The problem of antibiotic resistance begins with drug distribution and use in Bangladesh. Here antibiotics are sold over the counter at almost every pharmacy, without any doctor's prescription. Anyone can walk into a medicine store and buy antibiotics as per his/her wish or as per the advice of an untrained salesperson. Another problem is that many patients do not complete their full course of antibiotics thanks to ignorance of its impact. Stopping use of antibiotics halfway leaves behind the bacteria that have survived to develop resistance. When such patients get infected again, the same antibiotic no longer works. Experts say incomplete dose is one of the most dangerous contributors to the rise of resistant bacteria.

Over-prescription also plays a major role in antibiotic resistance. Many doctors prescribe antibiotics as a precautionary measure rather than a necessity while many patients expect doctors to prescribe the drugs for quick relief. The problem is further aggravated by the extensive use of antibiotics in livestock and aquaculture. Antibiotics are mixed into animal and fish feed to promote growth and prevent disease outbreaks, even when it was not necessary. These antibiotics eventually enter the human food chain through consumption of meat, eggs, and fish, as well as through contamination of soil and water. This way bacteria in humans and animals exchange resistance genes over time.

Bangladesh has laws and regulations in place to check indiscriminate use of antibiotics. Drugs Act of 1940 and its subsequent amendments require antibiotics to be sold only on prescription while a High Court verdict ordered the government to control the sale and use of antibiotics. Still the situation is getting worse with every day passing due to their lax enforcement.

Now the question is how we can combat the antibiotic resistance catastrophe. There is no easy way or shortcut to fight the phenomenon. We need to take a holistic approach to this. The government must effectively enforce existing laws, shutting down unlicensed pharmacies and penalising unauthorised sales of antibiotics where necessary. Pharmacists should be properly trained to prevent over-the-counter sale of such drugs. Doctors have a major role here. They need to strictly follow guidelines, prescribing antibiotics only when absolutely necessary while the use of antibiotics in animal farming must be regulated strictly.

Public awareness is most crucial to tackling improper use of antibiotics. Schools, health facilities and media outlets should launch campaigns against indiscriminate use of antibiotics so that people become aware of the dangers of the drugs' misuse. People must understand that taking antibiotics unnecessarily or not completing a prescribed course can endanger everyone.

rahmansrdk@gmail.com