Health catastrophe in the making

Amit Kar, 26, of Shalikha in Magura, was admitted to the intensive care unit at Bangabandhu Sheikh Mujib Medical University with unconsciousness and convulsion on November 18, 2018.
He sustained injuries in the head and chest in a traffic accident two days before his admission to the university hospital.
He was taken to three hospitals including Jashore Sadar Hospital and Dhaka Medical College Hospital in the two days.
ICU physician AKM Habibullah told New Age on Friday that Amit was yet to regain consciousness in about two months and a half.
‘He needs ventilation as he cannot breathe due to infection in the respiratory tract,’ he said.
Amit was infected with a superbug, Klebsiella, a bacterium that causes a range of diseases, depending on which part of the body it infects.
As Amit’s condition was not improving, doctors carried out a Tracheal aspirate cultures and sensitivity analysis on January 27.
‘The report was worrying. In Amit’s case, the Klebsiella was resistant to 16 types of antibiotics used in Bangladesh,’ Habibullah said.
‘The bacteria that infected the youth are sensitive only to the latest generation of antibiotic in medical science, Colistin Sulphate,’ he said.
‘If Amit is not cured by this antibiotic, or if the bacteria become resistant to this last option, everything will be over. He will have to wait for death,’ Habibullah said.
Like Amit, Sayeda Mehjabin, 38, was found unconscious in a nearby ICU bed.
She was admitted on December 23, 2018 with a brain haemorrhage and did not regain consciousness in 68 days.
Habibullah said that Tracheal aspirate cultures and sensitivity analysis found that Sayeda was infected with Acinetobacter bacteria, and it was resistant to all but one antibiotic, Colistin Sulphate.
‘Like Amit and Sayeda, about 20 per cent of the patients admitted to the ICU are infected by bacteria resistant to most or all the antibiotics,’ Habibullah said.
Doctors warned that a health catastrophe was in the making in Bangladesh because of antibiotic resistance caused by high rates of antibiotic use and misuse.
Once a bacteria becomes resistant to antibiotics, treating infection caused by the bacteria becomes difficult and in some cases, medically impossible. Untreated, bacterial infections can spread rapidly and may cause a health catastrophe, they said.
Because of widespread use of antibiotics, infectious bacteria develop the ability to survive the antibiotics exposure to antibiotics designed to kill them or stop their growth and become resistant to the antibiotics, they said.
The more antibiotics are used, the more resistant the bacteria can become as sensitive bacteria are killed, but stronger germs resist the treatment and grow and multiply. Repeated and improper use of antibiotics contributes to this process, they said.
Bangabandhu Sheikh Mujib Medical University pharmacology chairman Sayedur Rahman said that Colistin Sulphate was the latest antibiotic developed in the world.
‘In the next seven years, only one antibiotic is in the pipeline,’ he said.
‘If anyone suffering from infection caused by any bacteria resistant to the Colistin Sulphate, they had hardly any option to be cured,’ he said.
A study published in the March issue of International Journal of Infectious Diseases showed a horrific picture of antibiotic resistance against many common bacteria in Bangladesh.
The study titled ‘Antibiotic resistance in Bangladesh: A systematic review’ analysed 46 studies carried out in between 2004 and 2018 on antibiotic resistance in Bangladesh.
It found that bacteria which cause common ailments like urinary tract infection, pneumonia and ear infection were becoming resistant to most of the antibiotics in Bangladesh.
The study showed that Escherichia coli, a bacteria available even in jar water or street food in Dhaka and the most common causative organism of urinary tract infection, was studied in 21 articles and found high resistance to commonly used antibiotics — ampicillin in 94.6–100 per cent cases, amoxiclav in 67.1–85.5 per cent cases, ciprofloxacin in 65.2–80.5 per cent cases and co-trimoxazole in 72–82.2 per cent cases.
Resistance to ampicillin, amoxiclav, ciprofloxacin and co-trimoxazole was 100 per cent, 58 per cent and 67.4 per cent and 72.7 per cent respectively in Klebsiella bacteria that cause pneumonia.
Co-trimoxazole was ineffective against 86.6 to 98.7 per cent cases of tested Pseudomonas bacteria, which causes ear infection, and 87.5 to 100 per cent ineffective against Enterococcus bacteria, common among people who lacked the practice of hand wash after defecation.
Sayedur Rahman said that as there was a shortage of new antibiotics, it is of utmost importance that the existing ones are used cautiously.
‘Rampant taking of antibiotic, taking without maintaining due time, and not fulfilling course of antibiotic are the major reasons of growing trend of antibiotic resistance,’ he said.
The pharmacologist said that antibiotics were available at drug stores across the country and anyone seeking prompt cure from simple viral infection like fever, cold and diarrhoea, which did not require antibiotic to cure at all, used to buy antibiotics from the drug stores and take them whimsically.
Unregulated pharmacies and quacks are also contributing to the antibiotic resistance, he said.
‘There are about 2.3 lakh pharmacies and 4 lakh quacks in the country and they sell or prescribe antibiotics for unnecessary reasons rampantly,’ said the pharmacology professor.
Another reason of antibiotic resistance is that antibiotics are rampantly used in livestock which are being ended up in environment and directly to human through consumption of meat, he said.
Sayedur said controlled and lowered use of antibiotics could prevent resistance and this could be achieved by implementing strict regulations on antibiotic use, as well as by educating health professionals and the public, as irrational antibiotic use was common in Bangladesh through prescription and self-medication.
Doctors said that as the antibiotic business was profitable, pharmaceutical companies are eager to produce and market more antibiotics.
According to Drug Administration officials, antibiotic was the second best-selling drug in Bangladesh.
According to a review on the pharmaceutical industry business in Bangladesh by LankaBangla, the sale of antibiotic was Tk 1,687.61 crore in 2018, the second most sold medicines after acidity drugs.
Bangladesh Association of Pharmaceutical Industries secretary general SM Shafiuzzaman said that they produced medicines on market demands.
‘We don’t prescribe antibiotics and don’t promote to sell those without prescription, but we do business upon market demand,’ he said.
Drug Administration director Ruhul Amin said that they were aware of the growing trend of antibiotic resistance and taking measures, including awareness campaign and drive against sell of antibiotic without prescription, but those were not adequate.
He said a drug act which was drafted already proposed punitive measure for selling antibiotics without prescription.

News Courtesy: www.newagebd.net