Antimicrobial resistance (AMR) has emerged as one of the most pressing public health threats of our time. In Bangladesh, where infectious diseases remain a leading cause of morbidity and mortality, the rise of resistant pathogens poses a grave challenge to the health system. Without urgent action, the effectiveness of life-saving antibioticsāthe cornerstone of modern medicineāwill continue to erode, leaving communities vulnerable to infections that were once easily treatable.
The drivers of AMR in Bangladesh are multifaceted, but three stand out as direct causes:
Many patients and even healthcare providers remain unaware of the dangers of inappropriate antibiotic use. Self-medication, incomplete treatment courses, and the misconception that antibiotics cure viral illnesses are widespread.
Aggressive marketing practices and the easy availability of antibiotics without prescription have normalized overuse. Pharmacies often dispense antibiotics without proper guidance, prioritizing sales over stewardship.
While national action plans on AMR exist, weak regulatory enforcement and limited surveillance capacity undermine their impact. Policies often fail to translate into practice, leaving the health system vulnerable to unchecked misuse.
Even within clinical practice, antibiotic prescribing is often shaped by persistent misconceptions. Some prescribers assume that expensive antibiotics are better than cheaper ones. Similarly, the notion that fixed-dose drug combinations are always better has led to widespread use of broad-spectrum combinations that promote resistance. These misconceptions highlight the urgent need for evidence-based prescribing guidelines, and prescriber audits to reinforce rational practices in both hospital and community settings.
A crucial component of rational antibiotic use is antibiotic de-escalationāthe process of stepping down from broad-spectrum to narrow-spectrum antibiotics when culture results or clinical response indicate that a less potent agent will suffice. This approach minimizes unnecessary exposure to high-end antibiotics, thereby reducing selective pressure on pathogens and preserving antibiotic effectiveness. Integrating de-escalation into hospital antibiotic policies and stewardship programs can substantially improve treatment outcomes while curbing resistance.
At a recent dissemination seminar on WASH and AMR, the Chairperson of PHFBD, Professor Sharmeen Yasmeen emphasized a critical strategy: targeting school children to make a lasting impact. By embedding AMR education into school curricula, children can become powerful agents of changeāboth in their own behavior and within their families.
To break the cycle of resistance, Bangladesh must adopt a holistic approach:
The time to act is now. Without decisive steps, the unseen enemy of resistance will continue to grow stronger, threatening our health systems and also the very foundation of modern medicine.
1. World Health Organization. Empowering Bangladesh's next generation: confronting antimicrobial resistance through education and awareness. Geneva: WHO; 2023.
2. Institute for Health Metrics and Evaluation. The burden of antimicrobial resistance (AMR) in Bangladesh. Seattle: IHME; 2023.
3. Directorate General of Drug Administration. Steps to integrate the AMR issue into secondary educational curriculum. Dhaka: DGDA; 2023.
4. Directorate General of Health Services. National strategy and action plan for antimicrobial resistance containment in Bangladesh 2023ā2028. Dhaka: DGHS; 2023.
5. Zujbe Z, et al. The burden of hospital-acquired infections and antibiotic resistance in Bangladesh: current trends and policy implications. Discover Public Health. 2025;5:665.
Dr. Sharmila Huda, Vice-chairperson, PHFBD, is an accomplished Pharmacologist and Associate Professor in the Department of Pharmacology, Bangladesh Medical College, with a strong commitment to academic excellence and medical education.
Dr. Huda has served as a consultant in the development of Standard Treatment Guidelines (STG) for common infectious diseases in Bangladesh, under the Directorate General of Health Services (DGHS), ensured alignment with WHO's antimicrobial stewardship and AMR containment strategies.
She also served as a consultant for COVID-19 IPC and Pharmacovigilance (PV) support in Bangladesh under the USAID (MTaPS) Program. She is actively involved in research, particularly in areas related to rational drug use, and public health.
