Bangladesh Must Confront the Human Cost of Drug Resistance

Dr. Mohd Mizanur Rahman

Dr Mohammad Mizanur Rahman

Imagine a patient admitted to an intensive care unit (ICU) with severe pneumonia, a bloodstream infection, or sepsis. The medical team starts treatment, but the infection does not respond as expected. Laboratory results reveal that the bacteria are resistant to several commonly used antibiotics. Doctors must reassess the treatment, search for an effective alternative, and act quickly while the patient's condition may continue to deteriorate. For the patient and family, every passing hour brings uncertainty. For the medical team, the options may be dangerously limited.

Antimicrobial resistance plate.jpg - Wikimedia Commons

This is not a distant medical scenario. Research and surveillance in Bangladesh indicate that antimicrobial resistance (AMR) is already complicating the treatment of serious infections. The issue demands urgent attention, not through fear or exaggerated claims, but through evidence, accountability and action.

A deadly threat hidden behind a familiar medicine

Antibiotics transformed modern medicine. They made many previously life-threatening bacterial infections treatable and helped make surgery, cancer treatment, neonatal care and intensive care safer. Yet these achievements depend on antibiotics continuing to work against the bacteria they are intended to treat.

AMR develops when microorganisms evolve mechanisms that enable them to survive medicines that previously controlled or killed them. Antibiotic misuse and overuse accelerate this process, although resistance can also emerge and spread through other pathways, including healthcare transmission, inadequate infection prevention and the movement of resistant organisms between people, animals and the environment.

The global burden is substantial. A major systematic analysis published in The Lancet estimated that bacterial AMR was directly responsible for approximately 1.27 million deaths worldwide in 2019 and was associated with 4.95 million deaths [1]. These figures describe two different measures: deaths directly attributable to resistance and deaths associated with resistant infections. They must not be added together as if they were separate groups.

Bangladesh also faces a serious burden. Estimates cited in national and international AMR policy documents suggest that approximately 26,200 deaths in Bangladesh in 2019 were directly attributable to AMR [2]. This is a modelled estimate for 2019—not a count of deaths recorded in hospitals during the current year. Nevertheless, it provides a stark indication of the scale of the problem.

The ICU warning Bangladesh cannot ignore

The latest national surveillance findings make the situation particularly concerning in critical care. Bangladesh's Institute of Epidemiology, Disease Control and Research (IEDCR) published its National Antimicrobial Resistance Surveillance Report 2025, documenting resistance patterns among organisms identified through participating healthcare facilities [3].

According to reporting on the national findings, multidrug resistance was identified in 89% of ICU pathogen findings, while 41% were reported as suspected pan-drug-resistant pathogens [4]. These are alarming laboratory surveillance results. They do not mean that 89% of ICU patients die, or that 41% of all ICU patients have infections for which no treatment exists. They describe resistance among the relevant pathogens or isolates included in the surveillance data, not the proportion of all ICU admissions.

A separate study from icddr,b, published in 2026, provides a more direct and disturbing picture of patient outcomes. Researchers studied 373 critically ill adults admitted to the ICU of a tertiary government hospital in Dhaka between July 2023 and February 2024. Among patients who developed culture-confirmed infections caused by the difficult-to-treat resistant Gram-negative bacteria examined in the study, more than 90% died in the ICU [5].

That finding must be interpreted carefully. It concerns a specific group of patients with confirmed infections at one hospital; it is not the national ICU mortality rate. The patients were critically ill, and the researchers noted that limited treatment options, hospital-acquired infections, and resource constraints may have contributed to the exceptionally high mortality. The study does not establish that antibiotic misuse alone caused these deaths.

Even with those qualifications, the warning is unmistakable. When critically ill patients develop infections caused by bacteria resistant to commonly used antibiotics, treatment becomes much more difficult, and the consequences can be devastating.

The same study found that 105 of 198 patients who were initially free from the resistant bacteria acquired colonisation during their ICU stay [5]. Colonisation means that bacteria are present without necessarily causing an active infection. However, colonised patients may subsequently develop infection or transmit the organisms to others. This makes hospital infection prevention a central part of the AMR response, not an optional administrative exercise.

There was also evidence that practical action can save lives. After seven months of continued infection-prevention interventions in the study setting, bloodstream infections fell from 28 to 4 per 100 admissions, while mortality fell from 26 to 4 deaths per 100 admissions [5]. These results are encouraging, although they should be understood in the context of the study's setting and intervention rather than assumed to apply automatically to every hospital.

How everyday misuse creates tomorrow's emergency

A major part of the challenge begins outside the ICU. Antibiotics are often treated as routine remedies for fever, cough, sore throat and other common symptoms. Some people take leftover medicines, purchase antibiotics without a registered physician's prescription, stop treatment without professional advice or share medicines with relatives. Others expect antibiotics for illnesses that may be viral, against which antibiotics do not work.

Research from Bangladesh demonstrates the scale of non-prescription purchasing. A study of 128 community pharmacies documented 642 antibiotic courses and found that 50.9% had been purchased without a registered physician's prescription [6]. Another study, involving 385 antibiotic customers and observations of 1,000 dispensing events in selected urban and rural areas, found that 56.6% of surveyed customers had purchased antibiotics without a formal prescription from a registered medical practitioner [7].

These findings are concerning, but neither study should be treated as a nationally representative estimate of every antibiotic purchase in Bangladesh. They nevertheless identify a practical problem: antibiotics are being used in ways that may bypass appropriate diagnosis, prescribing and follow-up.

The responsibility cannot be placed solely on patients. People may self-medicate because consultations are costly, qualified care is difficult to access, pharmacies are more convenient or they have previously received similar medicines. Prescribers may face diagnostic uncertainty, pressure to satisfy patients or limited access to timely laboratory tests. Pharmacies need effective oversight, clear procedures and the support required to comply with the law.

Antibiotic resistance is not simply a story of irresponsible individuals. It is also a health-system challenge involving access, regulation, professional practice, public understanding and infection control.

When treatment becomes uncertain

Resistance does not mean that every antibiotic fails in every patient. It means that one or more medicines may no longer work against the organism causing an infection. Depending on the bacteria, infection site and laboratory findings, alternative treatments may still be effective. But some resistant infections leave clinicians with fewer options, more complex treatment decisions and a greater risk of delay.

For a family, this can mean prolonged hospitalisation, mounting expenses and the fear that a medicine which once seemed reliable may no longer be enough. For healthcare workers, it can mean treating a rapidly worsening infection while waiting for culture and susceptibility results. For hospitals, it means greater pressure on laboratories, isolation facilities, trained staff and infection-prevention systems.

The appropriate response is neither panic nor the assumption that medicine has become powerless. It is to ensure that patients receive the right treatment as early as possible, based on sound clinical assessment and laboratory evidence whenever indicated.

Bangladesh has a plan. Implementation must match the urgency.

Bangladesh's National Strategy and Action Plan for Antimicrobial Resistance Containment 2023–2028 provides a policy framework for surveillance, rational antimicrobial use, infection prevention, public awareness and a One Health approach linking human, animal and environmental health [2]. The central question is whether these commitments are being implemented consistently and measured transparently across the country.

First, antibiotic dispensing rules must be enforced fairly and effectively. Pharmacies should not supply prescription-only antibiotics without a valid prescription, and enforcement should be accompanied by training, public education and accessible alternatives for patients who need medical assessment.

Second, hospitals need stronger antimicrobial stewardship programmes. Antibiotics should be selected, reviewed and adjusted by qualified clinicians according to the patient's condition, likely pathogen, culture results and susceptibility testing. Hospitals should regularly audit antibiotic use and provide feedback to prescribers.

Third, diagnostic capacity must improve. Reliable microbiology laboratories, timely culture and susceptibility testing, and stronger referral pathways can help clinicians avoid unnecessary antibiotics and identify effective treatment sooner. Surveillance findings should be linked to clinical decisions rather than remaining only in annual reports.

Fourth, infection prevention must become a measurable patient-safety priority. Hand hygiene, environmental cleaning, appropriate isolation, safe device management, adequate staffing and continuous monitoring can reduce the spread of resistant organisms. The icddr,b findings show that stronger infection-prevention practices can coincide with substantial reductions in bloodstream infections and deaths [5].

Fifth, the government should publish regular, understandable data on AMR-related outcomes. Bangladesh needs clearer national reporting on deaths attributable to AMR, deaths associated with resistant infections, ICU infection rates, treatment outcomes, laboratory coverage and the effectiveness of interventions. Such reporting must distinguish estimates from observed counts and must not confuse resistance percentages with patient mortality.

Finally, public education must be sustained. Antibiotics should not be used for viral illnesses, shared with others or taken from leftover supplies. Patients should follow a qualified clinician's instructions and seek advice before changing or stopping a prescribed regimen. Public campaigns should explain that antibiotics are valuable medicines, not general-purpose treatments for every fever or infection.

Protecting the future of effective treatment

The most frightening aspect of AMR is not that all antibiotics will suddenly stop working. It is that the reliable treatment of common and severe infections can become increasingly uncertain, particularly where diagnostic services, infection control and access to effective medicines are limited.

Bangladesh has evidence of a substantial AMR burden, disturbing resistance patterns in ICU surveillance and a hospital-based study documenting extremely high mortality among patients with confirmed infections caused by difficult-to-treat resistant bacteria. The evidence is serious enough to demand action without exaggeration.

Every unnecessary antibiotic prescription, inappropriate dispensing decision, and preventable hospital-acquired infection can contribute to a wider problem. Conversely, every correctly prescribed medicine, timely laboratory result, effective hand-hygiene practice and prevented infection helps preserve treatment options.

The question is no longer whether Bangladesh should take AMR seriously. It is whether the country can turn its existing strategy into measurable action quickly enough to protect patients.

An antibiotic should remain a lifeline—not a medicine that arrives too late, or one that no longer works against the infection it was meant to treat. Bangladesh must act now to protect that lifeline for today's patients and future generations.

References 

1. Antimicrobial Resistance Collaborators. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet. 2022;399(10325):629-55. doi: 10.1016/S0140-6736(21)02724-0. 

2. Directorate General of Health Services, Ministry of Health and Family Welfare, Bangladesh. National strategy and action plan for antimicrobial resistance containment in Bangladesh, 2023–2028. Dhaka: DGHS; 2023. Available from: WHO-hosted document. 

3. Institute of Epidemiology, Disease Control and Research. National antimicrobial resistance (AMR) surveillance report Bangladesh, 2025. Dhaka: IEDCR; 2026. Available from: IEDCR official report notice. 

4. The Daily Star. Bangladesh AMR report: 89% of bacteria found in ICUs are multidrug-resistant. 2 Aug 2026. Available from: The Daily Star. 

5. Mamun GMS, Rahaman MS, Khan S, Islam MA, Sharmin S, Ahmed D, et al. Difficult-to-treat resistant Gram-negative bacteria and genomic resemblances between colonization and infection among patients in an intensive care unit of a tertiary care hospital in Bangladesh. Microbiol Spectr. 2026;14:e00121-26. doi: 10.1128/spectrum.00121-26. 

6. Islam MS, et al. Pattern of antibiotic dispensing at pharmacies according to the WHO Access, Watch, Reserve (AWaRe) classification in Bangladesh. 2022. Available from: PubMed. 

7. Masud AA, et al. Understanding antibiotic purchasing practices in community pharmacies: a potential driver of emerging antimicrobial resistance. Explor Res Clin Soc Pharm. 2024;15:100485. doi: 10.1016/j.rcsop.2024.100485. 

8. Mamun GMS, et al. Impact of targeted infection prevention and control interventions on bloodstream infections and colonization with carbapenem-resistant organisms among hospitalized neonates, Bangladesh, 2023–2024. Antimicrob Resist Infect Control. 2026. doi: 10.1186/s13756-026-01765-0.