Rafiqul Alam Khan

It was early February in 2020, when Dr. Anwar Hossain, an academic at the Department of Fisheries, University of Dhaka, was staying in Japan for his research work. For a while, he was conducting his research on the use of antibiotics in fish farming. Around the same time, the COVID-19 epidemic was unfolding in China, and WHO was yet to declare it as a pandemic. As the number of deaths rose in China, his attention momentarily shifted to the issue. He started digging deep and reviewing scientific papers as much as he could. Ironically he was sensing some similarities with the previous research, he has tried to find out the harmful impacts of antibiotic overdose or misuse. A few months later, he along with some of his colleagues (Prof. Dr. Raknuzzaman and Dr. Masahiro Tokumura) published a commentary on the concern about misuse of antibiotics against the backdrop of the coronavirus pandemic (https://www.jbiomedanalytics.org/index.php/biomed/article/view/44).

To give the readers a perspective, COVID-19, a respiratory disease caused by a virus called novel coronavirus (SARS-CoV-2) originated in Wuhan city of China. The virus transmitted from human to human and infection spread so dramatically that the World Health Organization (WHO) was forced to declare the situation a global pandemic. Owing to the fact that this is a completely new disease and there was no prescribed medication for it, doctors around the world started random trials with various drugs. In the commentary, published in the Journal of Biomedical Analytics, he cited that doctors in the USA are desperately using broad-spectrum antibiotics against the COVID-19 infected hospitalized patients. This also highlights another global health threat that has been mounting the threat of antimicrobial resistance. The UN reported that drug-resistant diseases cause at least 700,000 deaths every year and predicted to be increased to 10 million by 2050 if no immediate actions should be taken.

The spotlight here, Dr. Anwar and his co-authors showed their concern about the emergency of global antimicrobial resistance in their commentary submitted on May 5, 2020 whereas it took WHO at least a month to publicly announce it on June 1.

But, at his heart, he was worried mostly about his native country. Bangladesh is in the highest risk zone of antimicrobial resistance among all the WHO categorized regions, where sanitation, personal hygiene, and social distancing are not adequate. People are generally not concerned about viral or other contagious diseases. Here, self-medication is very common and prominent, and people stockpiled antibiotics with the misguided prospect of shielding them against the virus. Poor regulatory controls and the ease of availability have facilitated the use of antibiotics by general people. A recent study found that multidrug resistance (MDR) has rapidly increased in Bangladesh and grew nearly two-fold in 2019 compared to 2015.

Therefore, stringent policies and regulations are required to stop the misuse or overuse of antibiotics in Bangladesh. Otherwise, this may enhance and spread antibiotic resistances to the point of no return. Hence, Dr. Anwar’s five points recommendation are (i) improve awareness about the appropriate and rational use of antibiotics and prevent the misuse of antibiotics; (ii) regulate the appropriate disposal of expired/unused antibiotics; (iii) strengthen the surveillance and research; (iv) strengthen policies, programs and to ensure a robust national action plan to tackle antibiotic resistance; and finally (v) make information available on the impact of antibiotics and antibiotic resistance in developing and least developed countries.