Jihan Ara, aged 38, discovered in 2020 that she had developed resistance to 14 antibiotics following a COVID-19 infection. Medical professionals informed her that this resistance was due to incomplete courses or overdoses of the antibiotics prescribed. Currently, only a few antibiotics remain effective in her system.
Meanwhile, six-year-old Afrin Naba frequently suffers from fever and colds. Her mother, Monira Akhtar, reported that they would consult a doctor for high fever, who would prescribe medication for common colds and fevers. When the fever escalated, the doctor recommended antibiotics.
However, Monira admitted to not completing the full 7-day course, stopping after just three days when the fever subsided. Unaware of the necessity of finishing the antibiotic course regardless of symptoms, her daughter has also developed resistance to four antibiotics.
These cases highlight the urgent issue of antibiotic resistance, which poses a significant threat to public health and calls for increased awareness and responsible usage of medications.
The sale of antibiotics without a registered physician's prescription is a punishable offence.
On 18 September 2023, Drugs and Cosmetics Act, 2023 approved by Parliament, banning the sale of antibiotic drugs without a prescription from a registered doctor.
A visit to several pharmacies in Dhaka reveals that most pharmacists are either unaware of the new law or only a few rigorously enforce it.
Globally, from November 18 to 24, Antibiotic Awareness Week is observed, spotlighting the growing issue of antibiotic resistance. Experts are discussing the causes, prevention, and treatment of antibiotic resistance, along with relevant legislative actions.
What is Antibiotic Resistance?
Prof Shamsuzzaman, former head of the Microbiology Department at Dhaka Medical College, explains that excessive or improper use of antibiotics can cause bacteria in the human body to develop resistance, a phenomenon known as antibiotic resistance. He warns that indiscriminate antibiotic use inevitably leads to this problem. “The more antibiotics are used, the more bacteria adapt and become resistant,” he says.
Causes of Resistance
Dr Sajjad bin Shahid, current head of the Microbiology Department at Dhaka Medical College, told UNB that in Bangladesh, antibiotics are frequently given for simple ailments like colds or fevers, contributing significantly to resistance. He likens the spread of antibiotic resistance to infectious diseases, noting that resistant bacteria can be passed from person to person, spreading throughout communities.
In many developed countries, antibiotics cannot be bought without a prescription. However, this is not the case in Bangladesh, where the easy availability of antibiotics exacerbates the issue. Shahid also stresses that many people don't realise antibiotics are ineffective against viral infections, such as influenza, which constitute 99% of respiratory illnesses.
He hopes that the new law will curb indiscriminate antibiotic use. Previously, pharmacies selling antibiotics without a prescription were not penalised, but now mobile courts can enforce the law and impose fines.
DGDA’s Statement
According to Mohammad Nurul Alam, former deputy director and legal officer of the DGDA, antibiotic resistance causes the deaths of 5 million people annually, as per the World Health Organization (WHO). He mentions that previous public health laws were inadequate, necessitating the new regulation to prohibit the sale of antibiotics without a registered physician’s prescription. Under this law, violators can face fines of up to Tk 20,000 and the revocation of their pharmacy licences.
While many pharmacists remain unaware of these regulations, the DGDA assures that initiatives are in place to raise awareness.
Prevention and Solutions
Professor Shamsuzzaman emphasises the importance of performing antibiotic culture sensitivity tests before administering antibiotics. These tests identify which antibiotics will be effective against specific bacteria, though only 1% of patients in Bangladesh undergo this testing due to its cost and time consumption.
Experts recommend the following measures to combat antibiotic resistance:
• Establish clear policies on the appropriate use of antibiotics, including specific guidelines for prescribing.
• Ensure that patients complete the full course of antibiotics as prescribed.
• Launch public awareness campaigns on the dangers of misuse.
• Make culture testing available at hospitals and diagnostic centres across all levels.
• Enforce laws preventing unauthorised sales of antibiotics strictly.
Penalties for pharmacies dispensing antibiotics without prescription
The Director of the Directorate General of Drug Administration, Ashraf Hossain, told UNB that under Section 22 of the Drugs and Cosmetics Act of 2023, pharmacies found dispensing antibiotics without a prescription will face a fine of Tk 22,000. This regulation is legally enforced.
Enforcement actions will be conducted through mobile courts, leading to swift legal proceedings and execution of penalties. Violators risk having their licences revoked, he said.
To prevent such violations, steps will be taken to increase awareness among pharmacy operators and the public. Authorities will conduct visits to pharmacies to issue warnings, and measures will be implemented to ensure prompt punishment for anyone dispensing medications without a valid prescription, he added.