Self-medication by patients coupled with unrestricted retailing of antibiotics are a key reason for rising antibiotic resistance among people in Bangladesh, experts told a roundtable Sunday, calling upon the authorities concerned to take effective steps to rein in the sale of antibiotics without prescription.
At the same time, they recommended that the Directorate General of Drug Administration monitor prescriptions in order to reduce the use of unnecessary antibiotics and out-of-pocket expenditure of patients.
While addressing the discussion, "Antimicrobial resistance problem - prevent it together," Professor Dr Ahmedul Kabir, additional director general of the DGHS, said the Ministry of Health is working to stop the sale of antibiotics without prescription, he mentioned, adding, "But it is not enough, the prescriptions should be monitored." The prescription audit should be done by the drug administration directorate, he continued.
Prescription audits will help lower the number of drugs in prescriptions by around 50%, which will eventually reduce people's out-of-pocket expenditure, and drug resistance, he observed at the roundtable, jointly organised by the Directorate General of Health Services (DGHS), USAID, and Bangladesh Health Reporters Forum at Lakeshore Hotel in the capital.
Speaking at the event as chief guest, Professor Dr ABM Khurshid Alam, director general of the DGHS said out-of-pocket expenditures of patients are increasing because of excessive use of antibiotics.
He added that it is also a big issue whether the standard following which patients are treated in the country's hospitals is correct or not. If antibiotics are used correctly, there is no chance of infection.
"There is also a deficiency in hospital management. Hospital infection-prevention teams should take a serious look at whether OT rooms and surgical equipment are properly sterilised and used. If necessary, regular meetings should be held," he maintained.
Antibiotics are classified into three groups – Access, Watch, and Reserve – taking into account the impact of different antibiotics and antibiotic classes on antimicrobial resistance, to emphasise the importance of their appropriate use.
Professor Dr Ahmedul Kabir said most of the doctors in Bangladesh are not clear on which antibiotics fall in which group, and therefore often prescribe one type of antibiotic in place of another.
He urged the Communicable Disease Control wing of the health directorate to take up measures to give specific ideas to doctors about these three groups of antibiotics.
He suggested preparing separate guidelines for upazila-level hospitals, medical college hospitals.
Professor Dr Sania Tahmina, head of the Department of Microbiology at Green Line Hospital and former additional director general of the DGHS, in her keynote address said many patients with antibiotic resistance are being found in the ICUs (intensive care units) of public and private hospitals in Bangladesh.
The economic impact of antibiotic resistance is high, she observed.
She stressed infection prevention, usage control, and hygiene maintenance for preventing antibiotic resistance.