Bangladesh is facing one of its most severe public health challenges: antimicrobial resistance (AMR). The widespread misuse and overuse of antibiotics in hospitals, pharmacies, agriculture, and everyday community practices have placed the country at the forefront of a growing and silent crisis. This global observance offers an opportunity to reflect on national vulnerabilities, assess emerging data, and revisit the urgent actions required to prevent AMR from escalating into an irreversible public health disaster.
Recent national figures reveal a sharp and alarming rise in resistance trends. According to the Institute of Epidemiology, Disease Control and Research (IEDCR), antibiotic resistance has increased by 11 percent over the past five years, based on nationwide clinical surveillance conducted between 2017 and 2023. Critically important antibiotics are losing effectiveness at an unprecedented pace. Linezolid resistance has reached up to 82 percent in community settings, while resistance to carbapenems has risen to 84 percent, indicating a future where many severe bacterial infections may become untreatable.
Hospital settings, particularly intensive care units, present an even more disturbing picture. A BSMMU study found that 52 percent of ICU patients carried multidrug-resistant (MDR) bacteria, and 21.5 percent of infections occurred in cardiac, neonatal, pediatric, and kidney wards. Peripheral ICUs show similarly distressing results. Escherichia coli demonstrated resistance to 15 of 16 commonly used antibiotics, while Klebsiella pneumoniae and Staphylococcus aureus showed resistance to 12 antibiotics each.
Alarmingly, even colistin, considered a last-line therapy, exhibited resistance rates as high as 70 percent in some studies. National surveillance also highlights widespread ESBL-producing E. coli and nearly 48 percent methicillin-resistant Staphylococcus aureus in blood samples, underscoring the severity of the problem.
AMR is now deeply rooted in communities as well. Studies indicate that 78 to 82 percent of Enterobacterales in community samples are resistant to third-generation cephalosporins. Carbapenem and colistin resistance were detected in 9 percent and 11 percent of samples respectively. The emergence of ceftriaxone-resistant Salmonella Typhi carrying the blaCTX-M-15 gene illustrates how even common infections such as typhoid are becoming harder to treat.
Multiple human, environmental, and systemic factors drive this crisis. Overuse and misuse of antibiotics remain widespread. A point-prevalence survey across four tertiary hospitals in Dhaka found that 73.5 percent of inpatients received at least one antibiotic, with nearly half receiving multiple antibiotics. Only 31 percent of these prescriptions were guided by microbiological testing, showing that empirical and unnecessary antibiotic use remains common.
Self-medication further aggravates resistance. Despite legal restrictions, over-the-counter antibiotic sales remain prevalent, particularly in rural regions where many pharmacy outlets are run by untrained shopkeepers. Medications are often dispensed based on patient demand, leading to incorrect dosing and inappropriate drug selection, which accelerates resistance development.
Antibiotic use in livestock, poultry, and aquaculture is also poorly regulated. Antibiotics are frequently used for growth promotion and disease prevention, allowing resistant bacteria and drug residues to spread into the food chain, water systems, and surrounding environments. Weak regulatory enforcement and limited coordination under the One Health framework worsen the problem.
Diagnostic limitations in healthcare facilities further compound the situation. Many district and sub-district hospitals lack microbiology laboratories, forcing clinicians to rely on empirical treatment. Inadequate surveillance, insufficient infection control practices, understaffing, and a lack of antimicrobial stewardship programs create a fragmented national response. Cultural expectations among patients to receive antibiotics for common illnesses, including viral infections, also contribute to excessive and unnecessary consumption.
The consequences of rising AMR are profound. Drug-resistant infections result in longer hospital stays, more complications, and increased mortality. In critical care settings, resistance can leave clinicians with few or no effective treatment options. If current trends continue, Bangladesh could face up to 170,000 AMR-related deaths annually by 2050, surpassing the mortality of many current infectious diseases.
The economic burden is equally heavy. Resistant infections significantly increase treatment costs due to extended hospitalization, repeated testing, and the use of expensive reserve antibiotics. For many households, these expenses can be financially devastating. On a national level, AMR threatens productivity, strains healthcare resources, and undermines public health gains. If unchecked, even routine surgeries, childbirth, and common infections could become life-threatening, eroding public confidence in the healthcare system.
Addressing AMR in Bangladesh comes with significant challenges. Many hospitals lack graduate-level or clinical pharmacists, who play a key role in rational drug use and antimicrobial stewardship. Weak regulation enables unrestricted antibiotic sales. Limited diagnostic services and incomplete surveillance make evidence-based decision-making difficult. Public awareness remains low, while antibiotic use in livestock continues without sufficient oversight.
A comprehensive and coordinated strategy is urgently needed. Deploying qualified pharmacists across hospitals and community pharmacies is essential. In hospitals, pharmacists can review prescriptions, support rational therapy, conduct audits, and educate clinicians. In community settings, trained pharmacists can restrict unauthorized sales and counsel patients on appropriate antibiotic use. Strengthening regulation and ensuring strict prescription-only sales are equally critical. Coordination between human health, agriculture, livestock, and environmental sectors must improve under a unified One Health approach.
Antimicrobial stewardship programs should be implemented across healthcare facilities, guided by multidisciplinary teams including pharmacists, physicians, microbiologists, and infection control personnel. Expanding laboratory capacity for culture and sensitivity testing, along with stronger national surveillance systems, is vital for informed prescribing and effective monitoring.
Public education campaigns must play a central role in reducing unnecessary antibiotic demand. Schools, community groups, media, and religious institutions can help raise awareness. Incorporating AMR-related subjects into medical, nursing, veterinary, and pharmacy curricula will help develop a skilled health workforce capable of mitigating resistance.
Physicians must also demonstrate leadership through diagnostic-driven prescribing, regular audits, and adherence to treatment guidelines. Healthcare providers should resist pressure to prescribe antibiotics unnecessarily and collaborate with pharmacists to protect the effectiveness of existing drugs.
Bangladesh is undoubtedly facing a worsening AMR crisis, but swift and decisive action can still change the trajectory. Employing qualified pharmacists, enforcing regulations, strengthening diagnostics and surveillance, building stewardship programs, and raising public awareness can collectively help curb the rise in resistance. International Antibiotic Awareness Week must serve not only as a reminder but as a catalyst for coordinated national action. The choices Bangladesh makes today will determine whether future generations inherit a world where antibiotics remain life-saving medicines, or one where their power has been lost. Sustained, urgent, and unified efforts are essential to preserve antibiotic effectiveness for the people of Bangladesh and the generations to come.
[The author, Nazmul Islam, is a B.Pharm (professional) graduate from the Department of Pharmacy of Pabna University of Science and Technology]
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