A Future Without Working Medicine -Md. Kausar Uddin Ahmed

Antimicrobial resistance sounds like a big scientific term. But in real life, it looks like something very familiar. It looks like my aunty buying antibiotics from a corner dispensary. It looks like we are treating antibiotics like groceries.

Think antibiotics like our army. They fight against enemy bacteria. When bacteria enter our body, these antibiotic soldiers go and kill them. But what happens if every day we call the army to fight even when there is no war? What if we call them to fight mosquitoes, or argue with our neighbour, or settle family drama? The soldiers will get tired. The enemies will learn how to fight back. One day, when a real war comes, our army will stand weak and the enemy will be stronger. This is precisely what is happening to antibiotics.

Bacteria are living organisms. They are small, but they are very smart. They can learn and adapt very fast. When we take a particular antibiotic for the first time, most of the bacteria die, but some may survive because they are naturally a bit stronger or they did not get enough drug due to a wrong dose, a low dose, or because we stopped the medicine early. These surviving bacteria remember how to fight that antibiotic. They change their genes and become smarter. Next time when the same antibiotic comes, they are already trained to survive it. They also share this knowledge with other bacteria by passing genetic material. That’s why it is not like one bacterium becoming resistant; the whole community become warriors together.

Now, you may think this resistance will stay only inside those particular patients. Absolutely wrong thinking. These mutated bacteria can spread from one person to another just like normal infections. They can spread through air, water, food, touch, shared surfaces, and even inside hospitals. Therefore, one careless patient can create a threat for a whole family or even the whole community.

Moreover, many fungal infections are now resistant to antifungal medicines because we are taking antifungals without a prescription or proper diagnosis. Farmers also use antifungal chemicals in crops which mix with soil and water and help fungi become resistant. Viruses can also develop resistance to antiviral drugs. Even parasites like malaria are becoming resistant to drugs that once worked very effectively. This is already seen in many countries, and it makes treatment harder.

Antimicrobial resistance is an ecosystem problem. It is happening everywhere. In soil, water, animals, farms, food, hospitals, and inside our homes. For example, in poultry farms antibiotics are used to make chickens grow faster and to prevent disease. These drugs stay in the animals and enter our bodies when we eat them. They also leak into the environment and help microbes survive and adapt. It is about our whole lifestyle and the way we handle health, farming, and environment in Bangladesh.
I study pharmacy. I know about antimicrobial resistance. I give presentations. I read papers. I attend seminars. But I still could not stop what was happening inside my own home. My aunty buys antibiotics like chocolates. The local dispensary guy knows her name. They even suggest which antibiotic to take. No doubt, they are doing it for profit. No prescription. No consultation. Just business.

Then something serious happened. My cousin had a terrible accident. She lost half of her hand. She was admitted to the hospital. The doctors tried multiple antibiotics. One after another failed. Her body rejected most of them. She developed antibiotic resistance. Now, it was helplessness. It was money draining like water. They spent more than a lakh in hospital. And then finally they began to understand. But only a little bit. Because even after that, they gave antibiotics to my younger sister without thinking. And at the end of the day, that leads to another fifty thousand plus.

In Bangladeshi culture, age matters more than knowledge. If you are young, your voice is a toy. Relatives think they know better because they are older, louder, and more experienced in life. My education does not count in front of their confidence. I can make the public aware, but I am sorry to say that I cannot convince my own family. Our culture, habits, and health system all help microbes become resistant.

We are buying antimicrobials like groceries. In most of the villages and even cities, antibiotics and antifungals are sold openly without prescription. The seller acts like a doctor. The patient acts like a doctor. Everyone acts like an expert. And nobody is an expert.

Although there is a law to stop this. According to the Drugs and Cosmetics Act, 2023, Section 40(d), “Whoever sells antibiotics or any other drug without a prescription from a registered physician, except for over-the-counter drugs, shall be punishable with a fine which may extend to twenty thousand taka.”
Funny enough, and tell me honestly, do you see any proper enforcement of this law? Twenty thousand taka is not even a threat. Many pharmacies earn that in a day. The profit from illegal sales is much higher than the punishment.

Again, most of us stop taking medicine when they start feeling better. They never complete the full course. We trust neighbours more than medical literature. Cultural ego is bigger than science. Logic does not win in family gatherings; volume wins. If we continue like this, very soon simple infections will become life-threatening. A small cut may require hospital admission. Surgery will become dangerous. Cancer patients who rely on antibiotics after chemotherapy will suffer.

We are going back to an era before antimicrobials were invented. We are reversing our own medical progress. It is like building a huge building and slowly removing bricks from the foundation. One day the whole thing will collapse.

Everyone says hospital treatment is expensive. But what makes it expensive? Two things:

1. Resistant bacteria need stronger and costlier antibiotics, and

2. Longer hospital stays due to slow recovery.
If we use antibiotics, antifungals and other antimicrobials carefully, we can save our health and money. If we misuse them, we have to get ourselves ready to pay lakhs. Awareness starts at home. If we fail there, we will fail everywhere.