Some widely used antibiotics have lost efficacy up to 97 per cent in Bangladesh because of the misuse of the lifesaving drugs due to unregulated sale, over-prescription, self-medication and incomplete dosing as laws and High Court verdict are hardly followed.
A World Health Organization report found that several widely used antibiotics in Bangladesh are losing their effectiveness at alarming rates -- up to 97 per cent.
Though the laws and High Court directives are meant to curb the misuse antibiotics, they continue to be sold without prescriptions, and many doctors, experts say, prescribe broad-spectrum drugs unnecessarily.
Public health experts said that the government must monitor the antibiotics supply chain and servile prescriptions from the doctors, if they prescribe the drug unnecessarily.
Unless the misuse is reined in, they said, the country could face a future in which common infections become untreatable.
鈥榃ithout stopping prescribed misuse of antibiotics, you cannot stop nonprescription misuse,鈥� said Rashid E Mahbub, a former president of the Bangladesh Medical Association.
According to the Global Antibiotic Resistance Surveillance Report 2025 released by WHO on Monday, Acinetobacter spp.鈥攁 Gram-negative bacterium that causes bloodstream infections 鈥� showed an alarming 97 per cent resistance to imipenem, a powerful antibiotic used as a second-line treatment for severe infections.
Among Escherichia coli and Klebsiella pneumonia 鈥� two of the most frequent causes of bloodstream and urinary tract infections 鈥� resistance to third-generation cephalosporins and fluoroquinolones now exceeds 40鈥�60 per cent.
Bangladesh was reported to have some of the highest resistance rates in the South-East Asia Region, highlighting an urgent need for stronger surveillance, regulation, and stewardship.
Chief scientific officer Zakir Hossain Habib of the Institute of Epidemiology Disease Control and Research, however, explained that Bangladesh collected samples from tertiary hospitals where resistance rate was usually higher.
Dr Nitish Chandra Debnath, national lead for One聽 Health Bangladesh -- a holistic approach that recognises the interconnectedness of human, animal, and evironmental health -- said that the problem had persisted for over a decade, but the government did not respond accordingly.
聽He pointed to a hospital case. In Mymensingh Medical College Hospital, 80 per cent of the inpatients were prescribed antibiotics in 2022鈥�23; after interventions and awareness drives, the figure reportedly came down to 70 per cent.
He criticised that many quacks and unlicenced medicine shop workers routinely suggest antibiotics without any diagnosis, and even registered doctors often prescribed antibiotics without performing relevant sensitivity tests.
On the ground in Dhaka, medicine shops at Mirpur, Mohammadpur, and Farmgate continue to sell antibiotics openly without prescriptions.
The government has made a list of 39 medicine items only which can be sold without prescription, but antibiotics are not on the list.
According to Bangladesh Chemist and Druggist Samity鈥檚 former director Kazi Rafiqul Islam, sometimes customers force shopkeepers to sell antibiotics without prescription.
鈥業t is a cultural problem as well. People went to buy drugs without prescription and in cases take self-prescribed drugs as well,鈥� he said.
The Directorate General of Drug Administration director Akter Hossain said that in the past two years, the DGDA had realised fines totalling around Tk 8 crore on violators under the Drugs and Cosmetics Act, 2023, which bans antibiotic sales without prescription and allows fines of Tk 20,000 per violation.
Earlier, in 2019, the High Court directed the government to take effective steps to stop antibiotic misuse, but enforcement has largely failed.
In 2022, the Drug Administration had instructed all antibiotic manufacturers to adopt red labelling on antibiotic packs and include a warning: 鈥楧o not use without a registered physician鈥檚 prescription.鈥�
But many antibiotic products in local markets still do not carry these distinguishing marks.
There are over 250 pharmaceutical companies in the country and the majority of them produce antibiotics, said officials.
The Drug Administration has issued warnings to pharmaceutical companies missing the labelling deadline 鈥� but so far, no major penalties have been imposed.
Md Saiful Islam, the microbiology department head, at the National Institute of Laboratory Medicine and Referral Centre, said that if one develops Antimicrobial Resistance, medicinal interventions do not work in case of them against microorganisms like bacteria, virus, and some parasites.
鈥楶atients will die of very simple diseases as antibiotics would not work in their bodies,鈥� he said.
A DGDA study, unveiled in May 2022, showed that 67.3 per cent of the medicine retailers had no idea about the antibiotics sale restrictions and these shops sold them without prescription.
According to DGDA data, there are 1,53,000 licenced retail drug shops across the country, but Bangladesh Chemist and Druggist Samity officials estimated that the figure might be double as many drug shops operate without licence.
The misuse is not limited to human health only. In poultry, unnecessary antibiotics are routinely mixed into feed to boost poultry growth.
According to Professor Md Anwarul Haque Beg of Sher-e-Bangla Agricultural University, many farmers are instructed to use antibiotics even when birds are healthy, thereby encouraging the emergence of resistant bacteria.
鈥楾o increase meat or egg production, farmers are instructed to use them,鈥� he said adding that actually the antibiotics killed bacteria and hampered the digestive system.
He said that there were alternatives to the antibiotics, but those were comparatively expensive but safe.
A 2021 study by the Bangladesh Livestock Research Institute detected Salmonella strains which were resistant to 17 antibiotics in chicken samples from Dhaka鈥檚 wet markets, with resistance rates from 6.7 per cent to 100 per cent.
There are no data on deaths caused by superbugs in Bangladesh but physicians say a significant number of deaths at ICUs are caused by AMR.
According to experts, AMR is developing as well from the consumption of animal protein people take with antibiotic exposure. Salmonella is a key global diarrhoeal pathogen.
Health officials remain concerned that no reliable data on AMR-attributable deaths exist in Bangladesh.
But many ICU clinicians believe that mortality caused by drug-resistant infections is substantial and rising.
Experts said that existing laws were聽not strong enough, but real enforcement, better diagnostics, public education, and an empowered regulatory authority that can audit antibiotic use across sectors were also called for.
Without swift actions, Bangladesh risks sliding into a post-antibiotic era where even routine infections would become life-threatening.
