Imagine having to suffer through a life-threatening condition due to a minor infection or flu simply because the most common antibiotics are not working anymore? According to a study by ICDDRB, the effectiveness of 17 of the prevalent antibiotics in Bangladesh has decreased greatly. The apprehended crisis might be fuelled by a recent increase in the usage of antibiotics due to Covid-19. Prime Minister Sheikh Hasina herself has shared such concern. In a report run by Bangla Tribune, she recently said, “The number of effective antibiotics is decreasing. It may cause the world to fall into a new crisis which can be even deadlier than the coronavirus".
Around 75 years ago, Sir Alexander Fleming, the father of antibiotics and the saviour of millions of lives, himself predicted the deadliest apocalypse of all time- ‘The Antibiotic Apocalypse’. According to WHO, antibiotics have already become a global problem now.
According to the US Centers for Disease Control and Prevention (CDC), it occurs when even the bacteria that are simply preventable from causing lethal infections to the human bodies will become resistant to the very antibiotics that were created to kill them. Shortly after winning the Nobel Prize in 1945 for discovering penicillin, Fleming said, "The thoughtless person playing with penicillin treatment is morally responsible for the death of the man who succumbs to infection with the penicillin-resistant organism."
As explained by TED-Ed, just like any other living organism, bacteria also undergo genetic mutations, most of which are harmless. But in some of these mutations, one bacterium comes along a mutation that gives its organism an edge in survival. As the non-resistant bacteria are killed, which happens especially quickly in antibiotic-rich environments like hospitals, there are more scopes and resources for the resistant ones to thrive. They also multiply very quickly. In this way, the antibiotic-resistant 'league of superbugs' is created.
According to several studies, the reasons responsible are the overuse and misuse of antibiotics, self-medication without prescription, poor sanitation and hygiene in hospitals and clinics, etc. Another major source of antibiotic-resistant microbes is agricultural farms.
In many countries, animal, poultry and fish farmers indiscriminately use antibiotics as growth promoters. Drug manufacturing industries also do not dispose of their industrial waste appropriately, thus helping create leeching grounds for the resistant microbes.
Bangladesh is also a contributor to this global crisis as it is among the countries with the highest levels of antibiotic river pollution. At one location in Bangladesh, concentrations of a widely used antibiotic, Metronidazole, were 300 times above the limit, according to the findings of a research unveiled in Helsinki.
In Bangladesh, according to a study conducted by Poribesh Bachao Andolon (Poba) in 2016, about 56 per cent of antibiotics prescribed to patients in Dhaka hardly worked, as germs developed antibiotic resistance due to their extensive use. Another study conducted in an urban hospital in Bangladesh noted that 75 per cent of salmonella typhi were resistant to ciprofloxacin, an antibiotic.
Bangladesh allows the dispensation of antibiotics without a prescription, which leads to self-medication and dispensation of drugs by untrained people. In one survey from the Rajbari district, 100,000 doses of antibiotics had been dispensed without a prescription in one month. In another study, 92 per cent of medications dispensed by pharmacies were without prescriptions.
Bangladesh, as a member state of the UN and the WHO-SEARO (South East Asia Regional Office), has taken the initiative to implement integrated activities, including a national antibiotic surveillance system and laboratory network. Bangladesh is also taking part in the Global Antibiotic Resistance Partnership (GARP) project, supported by the Center for Disease Dynamics, Economics & Policy (CDDEP). It is committed to assisting with the National Strategy and Action Plan on AMR in preserving antibiotic effectiveness, slowing down the spread of AMR, and establishing a national capacity for antibiotic policy and access.
“In some emergency surgery cases, antibiotic resistance is often found. Some antibiotics that happen to be effective despite resistance are Tobramycin, Meropenem, Imipenem, etc.”, Dr Amirul Islam Bhuiyan, a consultant at Labaid Cardiac Hospital told The FE Outreach Team. “Misuse of antibiotics is quite easy in developing countries like ours. We are at the greatest risk. People die like termites here, but no strict data is kept of them. Hence, no precise data regarding the AMR death rate is yet available.” he added.
At present, about 700,000 people die a year from drug-resistant infections. However, this global figure is growing relentlessly and could reach 10 million a year by 2050. In an antibiotic-resistant world, even the simplest of the treatment processes would become ineffective. In abdominal surgery or appendix removal procedures, people will die of peritonitis or other infections without antibiotics.
Antibiotics are irreplaceable in transplant surgeries and these may no longer be effective in the future. The world will face the same risks as it did before the discovery of penicillin in 1928. “Routine surgery, joint replacements, cesarean sections, and chemotherapy also depend on antibiotics, and will also be at risk,” Jonathan Pearce, head of infections and immunity at the UK Medical Research Council, was quoted by thesouthafrican.com as saying. “Common infections could kill again,” he was also quoted to have said.
Maria Anis Chowdhury is a current student of mass communication and journalism at Dhaka University. She can be reached at mariachowdhury70@icloud.com