Public health experts said that AMR was on the rise in the country as the authority failed to stop the misuse of antibiotics even after the HC passed the directive in 2019 to stop the sale.
Anyone, they said, can still buy antibiotics without prescription while many quacks and medicine shop workers suggest antibiotics to patients without diagnosis.
The government has made a list of 39 medicine items only which can be sold without prescription, but antibiotics are not in the list.
According to Bangabandhu Sheikh Mujib Medical University pharmacology professor Md Sayedur Rahman, practically all the drugs in Bangladesh have become OTC items, including antibiotics.
He said that self-prescription, lack of knowledge and shopkeepers’ greed together with lax monitoring still kept the misuse of antibiotics resulting in antimicrobial resistance.
If one develops AMR, medicinal interventions do not work in case of him or her against microorganisms like bacteria, virus and some parasites.
Directorate General of Drug Administration director Md Ayub Hossain said that they decided to mark the packaging of antibiotic drugs with red marking and a warning like ‘Do not use without prescription of registered physician’.
‘We have also proposed a Tk 20,000 fine in addition to the present provision of cancelling licence of a pharmacy in the new drug control act for selling antibiotics without prescription,’ he said.
Ayub, also the DGDA spokesperson, said that the red marking and warning would help people become aware of the danger from using antibiotics without diagnosis and prescription by a registered physician.
Selling prescription drugs without a doctor’s prescription is an offence as it violates the conditions of a drug licence, he added.
The DGDA can cancel the licence of a pharmacy which violates the condition. But the drug regulator hardly takes any action against any errant medicine shop.
DGDA law officer Md Nurul Alam said that the draft Drug Bill 2022 was sent to the cabinet for replacing the Drug Act, 1940 and the Drug Control Ordinance, 1982.
Bangladesh Association of Pharmaceutical Industries general secretary SM Shafiuzzaman said that they had asked the pharmaceutical companies to follow the government directives, adding that some companies have already started packaging antibiotics accordingly while the rest are in the process of doing that.
‘Once the products now on the market are sold out, products in new packaging will be available in drug shops,’ he said.
He hoped that antibiotics in new packaging would hit the market by October 2022.
Ayub Hossain said that the medicine manufacturers were given six months for modifying the packaging.
The DGDA will take actions against those pharmaceutical companies which will fail to meet the deadline, he said.
He said that the DGDA could not monitor all the medicine shops because of their manpower shortage.
‘We will be getting more staff for the task,’ 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 the DGDA, there are 1,53,000 licensed retail drug shops across the country but Bangladesh Chemist and Druggist Samity officials estimated that the figure might be double as many operated without licence.
The association’s senior vice-president Abdul Hai said that the association was raising awareness among the pharmacy owners of the need to comply with the restrictions on the sale of the antibiotics, adding that it cannot take punitive actions against anyone for violations.
‘If the government takes actions against the unlicensed shops and illegal practices or take actions against fake medicines, we will help,’ he said.
BSMMU pharmacology professor Sayedur said that the new law was a good initiative but not enough to prevent the misuse and overuse of antibiotics.
‘A mass awareness campaigning is needed to inform people of the danger associated with the misuse of antibiotics,’ he said.
He also suggested incorporating the topic in school textbooks.
He said that self-medication by patients and the motive of medicine shops to make money by unrestricted selling of antibiotics as well as the lack of government monitoring were the reasons for the present situation.
He said that as high as 60 per cent of those who bought medicines used to purchase antibiotics, which should not be more than 20 per cent if the law and the regulatory measures were effectively in place.
According to the DGDA study, people spend 15 per cent of the medicine cost on antibiotics, which is huge, he said.
‘Antibiotic resistance poses a big risk in terms of both mortality and economic burden worldwide,’ he said, adding that global collective initiatives are also needed to address the problem.
The Global Research on Antimicrobial Resistance in April 2019 said that antimicrobial-resistant bacteria might have directly accounted for 1.27 million deaths in 2019.
The research estimated that antimicrobial resistance could cause 10 million deaths a year by 2050.
There is no data on deaths caused by superbugs in Bangladesh but physicians say a significant number of deaths at ICUs are caused by AMR.
Sayedur Rahman said that due to Covid-19 the situation became worse as people took more antibiotics during the pandemic by self-medication and sometimes physicians too prescribed it more as the last resort as there were no effective drugs.
He said that so far 13-15 basic antibiotics were developed in the world but many of them lost their efficacy while two to three new antibiotics, which would work in the current condition, were being developed but they were not forthcoming.
‘If antibiotics do not function, people will die due to very simple diseases,’ he pointed out.
The DGDA and the World Health Organisation in a joint study released in November 2019 showed that antibiotics consumption in Bangladesh had gone up by 30.81 per cent in the previous two years.
Meanwhile, a laboratory analysis, conducted by the BSMMU from 2010 to 2018, found a sharp rise in the number of superbugs in the country.
In 2010, superbugs and multiple-drug-resistant bacteria were detected in 6.5 per cent cases of all patients seen. But the rate increased up to 14 per cent in 2018, according to the study.
