ANTIBIOTIC resistance is increasingly becoming a global health crisis, primarily driven by the irrational, unnecessary, and non-compliant use of antibiotics. Research reveals that, in 2022 alone, over 3 million children worldwide succumbed to antibiotic-resistant infections. A study by two leading child health researchers highlighted that children in Africa and Southeast Asia are particularly vulnerable. Alarmingly, between 2019 and 2021, the resistance rate for 鈥榳atch antibiotics鈥� surged by 160 per cent in Southeast Asia and 126 per cent in Africa. According to the World Health Organisation, this issue has reached pandemic-like proportions. If antibiotics continue to lose their effectiveness, we will be left defenceless against infectious diseases.
In addition to these disturbing global trends, the National Drug Resistance Survey conducted by the Institute of Epidemiology, Disease Control, and Research in Bangladesh reveals that the resistance to some antibiotics has reached as high as 82-84 per cent, with the average resistance rate hovering around 50 per cent. Over the last five years, the resistance rate has increased by 11 per cent. In hospitals, the situation is even more concerning: the resistance rate to linezolid, a critical antibiotic, is 70 per cent in ICU patients and 82 per cent in the outpatient department. Carbapenem resistance is similarly high, at 84 per cent. A survey published by the Bangladesh Medical University鈥檚 Antimicrobial Stewardship programme found that 52 per cent of ICU patients in the hospital exhibit antimicrobial resistance. Alarmingly, reserve antibiotics 鈥� meant for only the most critical cases 鈥� are being overused, contributing to the crisis. In addition, self-medication, often involving antibiotics, is widespread due to easy access to pharmacies and a lack of awareness. This misuse, along with patients failing to complete prescribed antibiotic courses, accelerates resistance.
The global picture is equally grim. According to research by Yacob Habboush and Nilmarie Guzman (2023), antibiotic resistance has emerged as one of the most critical global health threats. Antibiotics, once powerful tools for curing deadly infections, are now being overused and misused, often without clinical benefit. Studies from 2015 revealed that around 30 per cent of outpatient antibiotic prescriptions in the United States were unnecessary, with acute respiratory infections accounting for nearly half of these. In the US, antibiotic resistance leads to an estimated 23,000 deaths annually and adds over $20 billion to healthcare costs. Resistance develops as bacteria adapt, mutate, and transfer resistance genes, leading to multidrug-resistant organisms like methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococci, and extended-spectrum beta-lactamase-producing Enterobacteriaceae.
In response, antibiotic stewardship programmes were launched and officially recognised by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America in 2007. These programmes aim to optimise antibiotic use through strategies such as clinician education, formulary restrictions, and real-time feedback mechanisms. Despite these efforts, many healthcare institutions, especially smaller ones, struggle with implementation due to limited resources. However, research highlights that effective stewardship programmes, supported by leadership, diagnostics, and interdisciplinary collaboration, are crucial to improving clinical outcomes, reducing resistance, and lowering economic costs.
Turning our attention to Bangladesh, a study by Md Mahadi Hassan and Noushin Nohor identifies antibiotic resistance as a pressing public health issue requiring urgent national action. The study points to several factors exacerbating the problem, including widespread irrational antibiotic use in both healthcare and agriculture, public misconceptions, and weak drug regulations. Alarmingly, 83 per cent of antibiotics are prescribed without proper diagnostic tests, and self-medication is rampant due to over-the-counter access and low awareness. Many patients also discontinue antibiotic courses prematurely, fuelling the cycle of reinfection and resistance. Moreover, antibiotics are overused in poultry farming without veterinary oversight. Surveillance data from 2016鈥�2023 shows an 11 per cent rise in antibiotic resistance over just five years, with some antibiotics losing up to 82 per cent of their effectiveness by 2023. The resistance is especially high in bacteria such as E. coli, Klebsiella spp., Staphylococcus aureus, and Salmonella spp. The study calls for a comprehensive national strategy, including antimicrobial stewardship, stronger surveillance, educational campaigns, and a 鈥極ne Health鈥� approach that involves healthcare, agriculture, and education sectors. It recommends implementing a national framework guided by WHO and CDC strategies, with a focus on sustainability, equity, and accountability.
A systematic review by Iftekhar Ahmed, Md Bodiuzzaman Rabbi, and Sakina Sultana, which examined 46 articles on antibiotic resistance in Bangladesh (published between 2004 and 2018), underscores the severity of the issue. The review found that antibiotic resistance is rendering many first-line antibiotics ineffective. It also highlighted significant gaps in ABR surveillance, with data available from only six of Bangladesh鈥檚 64 districts. The research found high resistance rates among pathogens like E. coli, Klebsiella spp., and Pseudomonas spp., while resistance to carbapenems remained relatively low. The prevalence of extended-spectrum beta-lactamase-producing organisms was notably high, indicating significant resistance to beta-lactam antibiotics. Despite these alarming findings, the study stresses the need for better surveillance and more stringent control over antibiotic use to mitigate the growing threat of antibiotic resistance.
To address this silent killer, we must take a multifaceted approach. This includes implementing antibiotic stewardship programmes, strengthening surveillance systems, and investing in widespread public education. It鈥檚 also critical to encourage collaboration across various sectors 鈥� healthcare, agriculture, and education 鈥� to effectively fight this growing problem and ensure that antibiotics continue to work in treating infectious diseases.
One of the most important steps in tackling this issue is raising awareness about the dangers of misusing antibiotics. In many rural areas, people often lack access to proper healthcare education and may turn to unprofessional pharmacists for medications. This is a major concern that needs urgent attention. By launching awareness campaigns and educating communities about the risks of antibiotic resistance, we can empower people to make better, more informed decisions about their health. This will help slow the spread of resistant infections. Public education is crucial in ensuring that antibiotics are used responsibly, helping to preserve their effectiveness for future generations.
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Nafew Sajed Joy is a writer and researcher.
