Excessive antibiotics use puts public health at risk: Experts

Mohammad Al Amin

9th October, 2019 11:29:45 printer

Excessive antibiotics use puts public health at risk: Experts

The trend of overuse and misuse of antibiotic entails health risk for people as there is hardly any effective antibiotic not prescribed to treat even most common or deadly diseases. 

Health experts said the growing trend of antibiotic resistance has become one of the most burning issues worldwide as it incurs a higher rate of mortality and economic burden.

“So far, resistance has developed in all available antibiotics. Initial problems of drug resistance were solved by the discovery of newer drugs. Now it appears that new antibiotics can’t keep pace with the development of drug resistance,” Prof Dr Ahmed Abu Saleh, chairman of Department of Microbiology at Bangabandhu Sheikh Mujib Medical University (BSMMU) told daily sun.

“Resistance bacteria are developing new resistance. Some bacteria have developed resistance to all available drugs but one. Some bacteria have acquired dozen or more resistance genes that can be transferred horizontally to other strain. A careless use of Antibiotics has contributed to the problem,” he added.

Describing the antimicrobial resistance situation in Bangladesh, the microbiologist said here the environment is congenial to the development and proliferation of antimicrobial resistant bacteria.

“We don’t have any national antimicrobial prescription policy. All classes of antibiotics are available in drugstores. Irrational use, suboptimal dose and poor adherence to medication are the primary reasons behind the increasing antimicrobial resistance in the country. Antibiotic-related topics are also not given emphasis for higher studies here,” he added.

According to experts, an Antimicrobial Resistance (AMR) is an inherent or acquired ability of bacteria or microorganism to develop resistance to drugs that scientists discovered and created to kill them.

“Antibiotic resistance is one of the biggest threats to global health, food security, and development. It leads to longer hospital stays, higher medical costs and increased mortality,” World Health Organisation (WHO) report said.

It said a growing number of infections – such as pneumonia, tuberculosis, gonorrhoea, and salmonellosis – are becoming harder to treat as the antibiotics used to treat them become less effective.

“The world urgently needs to change the way it prescribes and uses antibiotics. Even if new medicines are developed, without behaviour change, antibiotic resistance will remain a major threat,” it added. WHO observes World Antibiotic Awareness Week held every November since 2015 with the theme ‘Antibiotics: Handle with care’.

Dr Munirul Alam, a senior scientist working at Infectious Diseases Division (IDD) in International Centre for Diarrheal Disease Research (icddr,b), said antibiotic resistance has been a nightmare as there is no effective antibiotic left to treat the deadly infections in Bangladesh, and this was due to misuse of antibiotics in healthcare and agricultural sectors.

“The government should restrict the sale of antibiotics in all pharmacies without a physician’s prescription. Public awareness is very much important to reduce the misuse of antibiotic. The antibiotic drugs should be in fixed colour coated cover. The manufacture, prescription and use of antibiotic medicine should strictly adhere to WHO guidelines,” the scientist said.

Different studies reveal that developing countries like Bangladesh are more affected because of the overuse of antibiotics, widespread misuse of antibiotics, low quality drugs, malnutrition, use of non-human antibiotic, chronic and repeated infections and unaffordability of more effective drugs.

A report on antibiotic use and resistance in Bangladesh titled ‘Situation Analysis and Recommendations on Antibiotic Resistance’, said antibiotics are used clinically and misused either by oral, intravenous, intramuscular, intradermal or topical application by the patients. 

It is estimated that more than half of antimicrobials are inappropriately prescribed, dispensed or sold in Bangladesh, the report added.

Talking to the daily sun, some doctors warned that a health catastrophe is in the making in Bangladesh because of the serious situation of antibiotic resistance.

Dr AKM Habibullah, ICU (Intensive Care Unit) physician of BSMMU hospital, said about 80 to 90 percent of the patients admitted to ICU here are found to have antibiotic resistant.

 “Many patients are even resistant to all antibiotics available in Bangladesh and some are found sensitive to antibiotic Colistin Sulphate, the latest generation antibiotic in the world,” he added.

A study titled ‘Antibiotic resistance in Bangladesh: A systematic review’, analysing studies from 2004 and 2018 on antibiotic resistance in Bangladesh, found that bacteria which caused common diseases like urinary tract infection, pneumonia and ear infection were becoming resistant to most antibiotics available in Bangladesh.

Sources from pharmacologists said there are about 2.3 lakh pharmacies and 4 lakh quacks in the country and they sell or prescribe antibiotics rampantly.

“If the rampant use of antibiotic continues, then the antibiotics will be ineffective for human body in future and during that time no new antibiotic may be available to treat the patients,” Dr ASM Alamgir, Principal Scientific Officer of Institute of Epidemiology, Disease Control and Research (IEDCR) told daily sun.

Prof SM Lutful Kabir, head of Department of Microbiology and Hygiene of Bangladesh Agricultural University, said there is no option but to stop this practice to avoid antibiotic resistance.

“The unnecessary use of antibiotic to animals should be stopped. Antibiotic must be used according to prescription of registered veterinary doctor. Otherwise, it may also affect human being.”

According to World Health Organisation’s latest report on TB, which is caused by Mycobacterium tuberculosis bacteria, the annual incidence of multidrug-resistant TB in Bangladesh is 8,400. In 2017, at least 5,800 cases of multidrug-resistant TB were found, it added.

Doctors say as the antibiotic business is profitable, pharmaceutical companies are eager to produce and market more antibiotics, a reason responsible for the misuse of antibiotics as according to Drug Administration officials, the antibiotic was the second best-selling drug in Bangladesh.

According to a review on pharmaceutical industry business in Bangladesh by LankaBangla, the sale of antibiotic was Tk1,687.61 crore in 2018, the second most sold medicines after acidity drugs.

Bangladesh Association of Pharmaceutical Industries secretary general SM Shafiuzzaman told daily sun they produced medicines on market demands.