Tackling antimicrobial resistance in Bangladesh: A scoping review of policy and practice in human, animal and environment sectors

Abstract

Background Antimicrobial resistance (AMR) has become an emerging issue in the developing countries as well as in Bangladesh. AMR is aggravated by irrational use of antimicrobials in a largely unregulated pluralistic health system. This review presents a 'snap shot' of the current situation including existing policies and practices to address AMR, and the challenges and barriers associated with their implementation. Methods A systematic approach was adopted for identifying, screening, and selecting relevant literature on AMR situation in Bangladesh. We used Google Scholar, Pubmed, and Biomed Central databases for searching peer-reviewed literature in human, animal and environment sectors during January 2010-August 2019, and Google for grey materials from the institutional and journal websites. Two members of the study team independently reviewed these documents for inclusion in the analysis. We used a 'mixed studies review' method for synthesizing evidences from different studies. Result Of the final 47 articles, 35 were primary research, nine laboratory-based research, two review papers and one situation analysis report. Nineteen articles on human health dealt with prescribing and/or use of antimicrobials, five on self-medication, two on non-compliance of dosage, and 10 on the sensitivity and resistance patterns of antibiotics. Four papers focused on the use of antimicrobials in food animals and seven on environmental

Availability and price changes of potential medicines and equipment for the prevention and treatment of COVID-19 among pharmacy and drug stores in Bangladesh; findings and implications

“…There are also currently high rates of smoking in Bangladesh, up to 35% of the adult population, highest among the South East Asian countries 11,[33][34][35] , adding to the cost and burden of NCDs 35,36 , which also needs to be addressed. With respect to infectious diseases, there are concerns with high rates of antimicrobial resistance (AMR) in Bangladesh exacerbated by high rates of inappropriate prescribing and dispensing of antibiotics, including macrolides such as azithromycin [37][38][39][40][41][42] , which have resulted in a National Action Plan to try and address this 43 . Encouragingly for patients, prices of essential antibiotics in private pharmacies in Bangladesh, including model stores, were not much higher than international prices in a recent study by , with only limited price increases between 2003 and 2019 44 .…”

What contributes to inappropriate antibiotic dispensing among qualified and unqualified healthcare providers in Bangladesh? A qualitative study

“…Survey-based studies in Bangladesh among both qualified and unqualified healthcare providers (HCPs) show complex prescribing behaviours characterized by polypharmacy, high use of antimicrobials and almost non-existent generic prescribing [12][13][14]. Nationally, an estimated 63% of antibiotic prescriptions are from unqualified providers, and antibiotics are prescribed in nearly half (44%) of all consultations in primary health care [15].…”

Knowledge of antibiotics and antibiotic usage behavior among the people of Dhaka, Bangladesh

“…Bangladesh is a developing country with a high prevalence of antibiotic resistance where many of the first-line antibiotics have been reported to be mostly ineffective (Ahmed et al, 2019). Although the government prohibits the use of antibiotics without prescriptions , non-prescription use of antibiotics is widespread due to a lack of implementation of such laws (Hoque et al, 2020;Islam, 2006). Furthermore, most retail pharmacists in Bangladesh receive little or no training, and dispensing of drugs without prescriptions is very common (Ahmed et al, 2017).…”