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A UK-commissioned report fears of 10 million deaths due to antimicrobial resistance by 2050. This is the first instalment of a three-part series

Antibiotics, the basis of treatment against bacterial infections both in humans and animals, are losing their effectiveness, scientists and researchers have said.

Antibiotic resistance is a worldwide problem and Bangladesh is a major contributor to that owing to its poor healthcare standards, along with the misuse and overuse of antibiotics.

A study conducted by Poribesh Bachao Andolon (Poba) in 2016 revealed that about 56% of antibiotics prescribed to patients in Dhaka hardly worked, as germs developed antibiotic resistance due to their indiscriminate use.

Poba collected 305 samples of culture and sensitivity (C and S) of patients’ samples (cough, urine and blood) from three hospitals in the capital and tested those at government recognized laboratories to identify the nature of antibiotic resistance of germs in the human body.

The report revealed that antibiotic resistance has developed in the bodies of most city residents. Unchecked use of antibiotics in poultry, fish and veterinary feeds, and their unplanned use in treating diseases contribute to the increase in antibiotic resistance. Antimicrobial resistance threatens the effective prevention and treatment of an ever increasing range of infections caused by bacteria, parasites, viruses and fungi.

Saidur Rahman, associate professor of Bangladesh Medical College Hospital, told Dhaka Tribune: "While treating patients in recent years we have found that typhoid, urinary infection and diarrhoea are becoming resistant to most of the medicines available in the market."

Professor Dr Sayedur Rahman of Pharmacology Department of Bangabandhu Sheikh Mujib Medical University (BSMMU) said two antibiotics were discovered in 1994 and 2000, but before they were released, authorities found that some microbes have already developed resistance to them.

No major new class of antibiotics has been discovered since 1987, and too few antibacterial agents are in development to meet the challenge of multidrug resistance, he said.

"The research on antibiotics is highly expensive and time consuming. As very few scopes of antibiotics research remain, new high class antibiotics remain out of reach," he added.

He said the government has failed to take timely action against the deadly resistance. However, as later is better than never, few initiatives have been taken in recent times. But the steps need scaling up, he added.

Besides, irrational use of antibiotics in humans, little awareness among people and drug sellers, a weak surveillance process, and dearth of information about the health situation of the country are also contributing to the spread of antimicrobial resistance (AMR) in Bangladesh, said Dr Sayedur Rahmam.

Professor SM Mustafa Zaman of BSMMU Intervention Cardiology, who is also the secretary general of Physicians of Bangladesh, said people always have a misconception that once they start taking antibiotics, they are cured, hence, most often do not take doses regularly.

"But the fact is that if the patient stops using antibiotics, the bacteria would never go back to their previous state, they would evolve and make themselves resistant. And certainly, the prescribed medicines will be of no use to the patient," he added.

Munirul Alam, senior scientist of enteric infections at International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), said irrational use of antibiotics in animal feeds, especially in poultry farms, have scaled up the fear of AMR spreading in the country.

Besides, the environmental and defective water management in the city are also spreading AMR among the city people, he added.

A 2014 review commissioned by the United Kingdom government estimated that antimicrobial resistance (AMR) could cause 10 million deaths a year by 2050. The report on “Antimicrobial resistance: Tackling a crisis for the health and wealth of nations” was prepared by Lord Jim O’Neill and his team. It termed the estimation as a broad brush estimate, not a certain forecast.

The review said the results show considerable human and economic costs. Initial research, looking only at part of the impact of AMR, shows that a continued rise in resistance by 2050 would lead to 10 million people dying every year and a reduction of 2% to 3.5% in Gross Domestic Product (GDP). It would cost the world up to US$100 trillion.

However, with a huge population, the success in Millennium Development Goals (MDGs) of Bangladesh has come as a surprise to the world community.

Researchers and physicians in the country said the main reasons of the achievement were controlling infectious diseases and increase in vaccinations, reducing reproductive health hazards, and ensuring minimum hygiene, especially in rural areas.

Now, they are scared that the progress in health sector would be hampered as improper use and consumption of antibiotics, both by humans and animals, are increasingly forming resistance among people. And lack of timely measures make it impossible for the government to do surveillance on the worsening AMR situation.

That is also obstructing the government and researchers from finding out the real scenario about how the environment and other factors are evolving, they said.

Effective antimicrobial drugs are prerequisites for both preventive and curative measures, protecting patients from potentially fatal diseases and ensuring that complex procedures, such as surgery and chemotherapy, can be provided at low risk.