Antimicrobial resistance: Bangladesh experience

Infectious diseases are major health problems in Bangladesh requiring frequent use of antimicrobials. Diagnosis and treatment of most of the bacterial diseases are empirical. Microbial sensitivity patterns of common infections like respiratory tract infection, urinary tract infection, enteric fever, wound infection are not routinely available for decision making in drug selection. Many infectious diseases do not respond to conventional antimicrobial agents. Standard treatment guidelines of different microbes are not sufficient for the purpose, moreover the community awareness programme is imperfect. There is no routine antimicrobial surveillance or quality assurance in place. Multidrug resistant (MDR) TB in primary infection is ~3%, and MDR enteric fever is an emerging threat in Bangladesh. Due to drug resistant falciparum malaria, artemisinin-based combination therapy is used; visceral leishmaniasis is treated with oral miltefosine although sodium stibugluconate is still sensitive but found to be at times toxic and difficult to deliver. Available evidence does not support the optimal diagnosis and treatment of bacterial infections in Bangladesh. Antibiotics are available as non-prescription drugs in medicine shops and irrational use is not uncommon. Adherence to treatment protocol and compliance with treatment course of antimicrobials need to be emphasized at different levels. Measures for prevention and containment of antimicrobial resistance are necessary in Bangladesh. It should be taken as a national priority and the establishment of a national alliance or regulation governing the use of antimicrobials should be considered.