It began in an ordinary middle-class family in Dhaka. Seven-year-old Rayan developed a fever. His father went to a nearby pharmacy and asked for "a strong antibiotic." Without any prescription, the medicine was handed over. After taking it for three days, the fever subsided, and the medication was stopped midway.
A few months later, the infection returned. This time, the same antibiotic no longer worked. Eventually, they consulted a physician, who warned that the bacteria had likely become resistant to the drug.
This is not only Rayan's story. It reflects the growing reality of millions of people in Bangladesh and around the world. Gradually, humanity is moving toward a future where common infections, minor surgeries, and even childbirth may once again become life-threatening. In medical science, this crisis is known as Antimicrobial Resistance (AMR) - often described by global health experts as a "Silent Pandemic."
What is AMR and Why is it Dangerous?
Antimicrobial Resistance occurs when bacteria, viruses, fungi, and other microorganisms develop resistance against medicines designed to kill them. As a result, antibiotics and other antimicrobial drugs that once effectively treated infections gradually lose their power.
Antibiotics do not attack the human body; they target harmful bacteria. However, when antibiotics are used unnecessarily or incorrectly - such as taking them for viral colds and flu, stopping medication midway, or using antibiotics without medical advice - some germs survive. Over time, these surviving organisms become stronger and evolve into what are commonly known as "superbugs."
The most alarming aspect of AMR is that it spreads silently. Resistant germs are now circulating through hospitals, households, food, water, and the environment, increasing the global risk of difficult-to-treat infections.
A Growing Global Health Threat
According to the World Health Organization and international research, nearly 1.27 million people died directly from drug-resistant infections in 2019, while AMR was associated with almost 5 million deaths worldwide.
If current trends continue, experts warn that by 2050, AMR could claim more than 10 million lives every year - potentially surpassing deaths caused by cancer.
Why Bangladesh is at Greater Risk
In Bangladesh, antibiotics are alarmingly easy to obtain. In many areas, even powerful antibiotics can be purchased without a prescription. Fever, diarrhea, cough, sore throat - antibiotics are often used indiscriminately for almost every illness. In many cases, pharmacy workers themselves recommend and dispense these medicines.
Research suggests that thousands of deaths in Bangladesh every year are linked to AMR. In 2021 alone, an estimated 96,900 deaths were associated with antimicrobial resistance, including around 23,500 deaths directly caused by resistant infections or "superbugs."
Experts also warn that resistance rates among some bacteria have already exceeded 90 percent against commonly used antibiotics.
How Are "Superbugs" Created?
Superbugs develop when bacteria and other microorganisms are repeatedly exposed to antibiotics and gradually acquire the ability to survive against them. In simple terms, medicines that once killed these germs no longer work effectively.
The major drivers behind this crisis include:
1. Misuse and Overuse of Antibiotics:
• Taking antibiotics without medical advice
• Using antibiotics unnecessarily for viral fever, cold, or flu
• Not completing the full prescribed course
• Following someone else's prescription
• Inappropriate or unnecessary prescribing practices in some cases
2. Lack of Awareness:
Many people still do not understand that antibiotics do not work against viral infections. Unnecessary antibiotic use today may make future treatment ineffective.
3. Weak Infection Prevention and Control:
Many hospitals and healthcare facilities still lack proper infection control systems. Overcrowding, inadequate sterilization, and poor hygiene practices allow resistant organisms to spread more rapidly.
4. Excessive Antibiotic Use in Agriculture
and Livestock:
Antibiotics are widely used in poultry, fisheries, and livestock farms to promote rapid growth and prevent disease. Resistant germs from these sources can spread to humans through food, water, and the environment.
As these powerful resistant organisms survive and spread, particularly in crowded communities, hospitals, schools, daycare centers, and unhygienic environments, even common infections can become severe, prolonged, and sometimes fatal.
A Threat to Modern Medicine
If this trend continues, a time may come when effective antibiotics no longer exist. Modern medical procedures such as cesarean sections, cancer chemotherapy, organ transplantation, intensive care treatment, and neonatal care could become extremely risky or nearly impossible.
Antibiotics are essential for preventing and treating infections during these procedures. Without effective drugs, the risks of complications and death will increase dramatically.
The Importance of the "One Health" Approach
Experts are increasingly emphasizing the "One Health Approach" to combat AMR.
One Health is an integrated and collaborative strategy that recognizes the close connection between human health, animal health, and the environment. Resistant germs can spread through contaminated food, polluted water, livestock farms, and environmental waste.
Therefore, AMR cannot be addressed by hospitals alone. Coordinated action involving healthcare, agriculture, livestock, food safety, and environmental sectors is essential.
What Can the Public Do?
• Combating AMR is not solely the responsibility of governments or healthcare professionals.
• Public awareness and responsible behaviour are equally important.
Individual Responsibilities
• Avoid taking antibiotics without a doctor's advice
• Do not misuse antibiotics unnecessarily
• Complete the full prescribed course
• Never use another person's prescription
• Avoid storing or reusing leftover antibiotics
Community-Level Actions
• Increase public awareness about AMR and antibiotic misuse
• Promote regular handwashing and hygiene practices
• Discourage unnecessary antibiotic use in agriculture and livestock
Healthcare System Measures:
• Ensure routine vaccination for children
• Strengthen infection prevention and control in hospitals
• Enforce stricter regulation on antibiotic sales
• Improve laboratory facilities and surveillance systems
Time to Act Before It Is Too Late
There was a time when antibiotics were considered miracle drugs. Today, that miracle is slowly fading away.
Without immediate awareness and effective action, common infections may once again become deadly. The question now is simple:
Will we act before it is too late, or will we witness a future where humanity destroys the power of antibiotics through misuse and negligence?
Dr Marufa Afrin Mohona is Resident Medical Officer at Square Hospital.
marufa.mohona.251@northsouth.edu
Dr Shyama Prosad Mitra is Senior Consultant Anesthesiologist at Evercare Hospital, Dhaka.
mitra.apollo@gmail.com
Dr Mohammad Zahirul Islam (Bayazid) is Assistant Professor at North South University, Dhaka.
islam.mohammad02@northsouth.edu