Antimicrobial Resistance: It’s worsening amid pandemic

Different bacteria have already developed resistance to most life-saving antibiotics, but widespread irrational use of the drugs during the pandemic have raised fears of even more drug-resistant germs.

Researchers say many drugs might have lost their effectiveness due to over-use during the Covid-19 outbreak.

"We assume that around one crore people in Bangladesh had suffered Covid-19-like illnesses, and almost all took antibiotics and other drugs... This way, these drugs lost their effectiveness against the germs," Prof Sayedur Rahman, chairman of pharmacology at the Bangabandhu Sheikh Mujib Medical University (BSMMU), told The Daily Star yesterday.

The day no antibiotic will be effective has come closer, he feared.

"Very soon, we will have no drug to treat bacterial infections. But in the coming years, there will only be three new drugs."

The preliminary result of an ongoing surveillance study published on November 24 last year said 17 antibiotics were becoming ineffective in killing the 10 types of bacteria that cause urinary tract infection, septicaemia, diarrhoea, pneumonia, and wound infection among other diseases.

The study being done by the Institute of Epidemiology, Disease Control and Research (IEDCR), found, for example, the widely-prescribed ceftriaxone ineffective in combating E-coli, proteus spp, non-typhoidal salmonella and Acinetobacter complex and other bacteria in many cases.

Dr Zakir Hossain Habib, head of microbiology and principal scientific officer at the IEDCR, who has been leading the study, said, "There is no chance of improvement; irrational use of antibiotics is more common now than at any other time. Even the reserve drug Imipenem is being used indiscriminately."

The World Health Organization classifies antibiotics in "access group", used for a wide range of primary-level infection, "watch group" used for higher resistance bacteria, and "reserve group" used when all alternatives fail.

Dr Habib added that laboratory analyses done between 2017 and 2019 found that Imipenem was becoming ineffective in treating different bacteria. "Only a few other antibiotics are left if these don't work."

In its 22nd meeting on Sunday, the National Technical Advisory Committee (NTAC) on Covid-19 also said there was "irrational use" of antibiotics because the national Covid-19 treatment protocol was not being followed in many hospitals. This resulted in antimicrobial resistance (AMR).

According to a Global Antibiotic Resistance Partnership (GARP) report titled Antibiotic Use and Resistance in Bangladesh 2018, the use of counterfeit or poor-quality antimicrobial medicines, weak laboratory capacity, and inadequate drug monitoring and surveillance are among the main reasons behind the rise of AMR.

Besides, the report said that poor treatment adherence, non-therapeutic use of antibiotics for growth promotion in farm animals, self-medication and over-the-counter access to antibiotics are to blame for AMR growth.

Besides, there was no progress in surveillance during the pandemic, experts said.

The Center for Disease Control (CDC) of the Directorate General of Health Services organised an event on Sunday involving researchers from different government departments and global development agencies to discuss the Draft National AMR Surveillance Strategy 2020-25.

Discussants said the AMR was going to pose a bigger threat than the pandemic in the years to come and a coordinated effort was needed because AMR was making its way into the food chain.

Addressing a plenary session, Dr Mahmudur Rahman, former director of the IEDCR, said the research on AMR was inadequate.

Pointing to the aggressive marketing by pharmaceutical companies to promote antibiotic drugs, he stressed on regular information dissemination among physicians so that they can select the right drug for the patients.