A Nation on the Brink of a Post-Antibiotic Apocalypse
H. M. Nazmul Alam :
The modern miracle of antibiotics once transformed the course of medicine.
What was once fatal became curable, and the world entered an age where infections could be subdued with a few pills. In Bangladesh, that miracle is now fading fast.
Several widely used antibiotics have lost up to 97 percent of their effectiveness, according to a recent global report. Behind this alarming decline lies a national pattern of misuse, negligence, and regulatory paralysis.
For decades, antibiotics in Bangladesh have been treated as ordinary commodities.
They are sold in open markets and pharmacies without prescriptions, prescribed unnecessarily by doctors, and consumed indiscriminately by the public.
The problem is widespread and deeply rooted. While the law strictly prohibits the sale of antibiotics without medical prescriptions, the reality across Dhaka and other major cities tells a different story.
In many retail drug stores, antibiotics are handed out as casually as paracetamol.
This unregulated access has allowed bacteria to adapt, evolve, and render the most powerful drugs nearly useless.
The World Health Organization’s 2025 surveillance report shows the consequences in stark numbers.
The bacterium Acinetobacter spp., a cause of severe bloodstream infections, now shows 97 percent resistance to imipenem, one of the strongest antibiotics used for serious infections.
Resistance among Escherichia coli and Klebsiella pneumoniae, two of the most common agents of urinary tract and bloodstream infections, has surpassed 40 to 60 percent for major antibiotic classes such as cephalosporins and fluoroquinolones.
Bangladesh now records some of the highest resistance rates in the South-East Asia region, signaling a public health emergency.
The crisis is not the product of sudden mutation but of years of unchecked misuse. More than 150,000 licensed retail drug shops operate across the country, yet estimates suggest the number of unlicensed shops may be nearly double.
A government study found that over 67 percent of medicine retailers were unaware that selling antibiotics without prescriptions was illegal.
Many of these retailers sell antibiotics upon customer request without even asking about symptoms or prior prescriptions.
This ignorance, combined with weak enforcement, has turned community pharmacies into breeding grounds for antimicrobial resistance.
Data from hospitals paint an equally troubling picture. In one large medical college hospital, nearly 80 percent of inpatients were prescribed antibiotics in 2022. Even after awareness campaigns, the figure fell only to around 70 percent.
The problem lies not only in over-the-counter misuse but also in excessive medical prescription. Many physicians prescribe broad-spectrum antibiotics as a precaution rather than as a necessity.
In a culture where patients expect medication at every consultation, doctors often respond with antibiotics to meet expectations or to save time on diagnostic tests. Each unnecessary prescription accelerates bacterial resistance.
The regulatory response has been largely superficial. Over the past two years, the Directorate General of Drug Administration (DGDA) collected fines of about Tk 8 crore from violators of the Drugs and Cosmetics Act 2023, which prohibits antibiotic sales without prescriptions.
The law allows for penalties of Tk 20,000 per violation, yet the scale of enforcement is insignificant compared to the scope of the problem.
The same authority reported that while antibiotics were ordered to be sold with red warning labels in 2022, many local products still circulate without the required markings.
Bangladesh’s pharmaceutical sector, with over 250 companies producing antibiotics, remains only loosely supervised.
The situation in agriculture mirrors the same negligence. In poultry and livestock farming, antibiotics are widely used not for treatment but for growth promotion and disease prevention, even when animals are healthy.
This practice introduces antibiotic residues into the food chain and encourages resistant bacteria to spread from farms to humans.
Studies have found that Salmonella strains isolated from chicken meat in Dhaka’s markets showed resistance to as many as 17 different antibiotics, with rates ranging from 6 to 100 percent.
Such findings indicate that antibiotic misuse in agriculture directly contributes to resistance in human populations through food consumption.
The consequences are already visible in hospitals and intensive care units. Although there are no official national statistics on deaths caused by antimicrobial resistance, physicians across major hospitals report that many patients die because infections do not respond to any available drugs.
These deaths are often recorded under generic terms such as “septicemia” or “multi-organ failure,” masking the true scale of the resistance crisis.
The absence of a national database or coordinated surveillance system has made the problem invisible to policymakers, even as it worsens silently.
The economic implications are no less severe. As infections become harder to treat, patients require longer hospital stays and more expensive second-line or third-line antibiotics.
This drives up healthcare costs and increases the burden on an already strained health system.
Resistant infections also threaten to undermine export sectors such as poultry and pharmaceuticals, where traces of antibiotics in products could trigger international trade restrictions.
The existing laws and fines are not enough. What Bangladesh needs is a transformation in public behavior and institutional responsibility.
Regulatory agencies must actively monitor drug sales rather than relying on occasional raids. Prescription audits should become mandatory in both public and private hospitals.
Antibiotic stewardship programs, which train healthcare professionals to use antibiotics rationally, should be introduced in every medical college and hospital.
Public awareness campaigns must shift from posters and slogans to practical education on when antibiotics are necessary and when they are not.
Better diagnostics can also play a key role. Most antibiotic prescriptions are made without laboratory tests because facilities are inadequate or patients cannot afford them.
Expanding affordable diagnostic services could prevent unnecessary use of antibiotics by ensuring that prescriptions are based on confirmed bacterial infections rather than assumptions.
The pharmaceutical industry must also take responsibility. Companies should be legally bound to ensure proper labeling, distribution, and reporting of antibiotic sales.
Red warning labels must be mandatory on all antibiotic packs, and non-compliance should result in substantial financial penalties and license suspensions.
Ultimately, the solution lies in treating antibiotics as a precious resource rather than a consumer product. Bangladesh’s progress in health, economy, and human development risk reversal if antibiotic resistance continues unchecked.
The numbers already point toward a national emergency: 97 percent resistance in key bacteria, 70 percent antibiotic use among hospital inpatients, 67 percent ignorance among drug retailers, and over 300,000 pharmacies selling these drugs with minimal oversight. These figures are not abstract—they represent a system unraveling from within.
If decisive measures are not taken now, Bangladesh could soon enter a post-antibiotic era where common infections, surgeries, and childbirth become life-threatening once again. The miracle drugs that once symbolized human advancement may turn into silent witnesses of collective failure.
The bacteria will continue to evolve as they always have. The question is whether the country will evolve its systems, ethics, and discipline fast enough to survive them.
(The author is an Academic, Journalist, and Political Analyst based in Dhaka, Bangladesh. Currently he is teaching at IUBAT. He can be reached at [email protected]))