Antimicrobial resistance (AMR) is a rapidly growing health crisis with severe repercussions in the absence of countermeasures. 

The role of pharmacists in this context should be defined by their presence in the community and facility network and their clinical expertise as drug advisers. In Bangladesh, AMR has atrophied the efficacy of many first-line antibiotics, resulting in an increase in the cost of treatment, frequency of treatment failures, and higher risks of mortality from bacterial infections. 

But how can pharmacists help tackle AMR in Bangladeshi communities?

For World Antimicrobial Awareness Week, Abdur Rahman, a pharmacist in Bangladesh, shares how pharmacists are helping to tackle antibiotic resistance in the country.

Abdur Rahman:

Although pharmacists worldwide have a phenomenal responsibility to take prominent roles in  antimicrobial stewardship programs as well as in the infection prevention and control programs of  health systems, in Bangladesh, pharmacists need to be more widely engaged in the AMS. Hospital pharmacy is not well established here and is limited to only a few private hospitals in the  capital region. 

Though community pharmacies are available in local areas, they are not regulated by graduate pharmacists. As a result, the role of pharmacists in tackling AMR is not that substantial, and national antimicrobial surveillance data and antimicrobial stewardship programs are not actively present either in government or private hospitals. 

However, the good news is pharmacists’ involvement in the AMS program is gradually increasing in recent days. The government has introduced model pharmacies at the community level throughout the country that are managed and supervised by graduate pharmacists. 

Pharmacists in these areas often provide patients with prescribed antibiotics, dosage regimens, and other necessary guidance. Several stakeholders and a community of pharmacists, for example, Bangladesh AMR  Response Alliance (BARA), are working towards successfully implementing AMS programs by training, social gathering, and creating awareness among physicians and general people.  

Pharmacy services and professions in developing countries like Bangladesh are still limited to roles mainly in the drug manufacturing industry, medicines procurement, drug dispensing,  and drug supply chain and storage maintenance. So, pharmacists are being trained here for their industrial careers. 

However, the great news is that the scenario is gradually changing, and pharmacists are getting involved in patients’ care in different settings. This will create more opportunities for us in fighting AMR.

Some of the challenges we have come up against:

1. Lack of awareness: The most significant challenge pharmacists face in implementing AMS is the lack of awareness among the people. First of all, most people are not aware of  antimicrobial resistance.

In fact, a significant number of the population do not know that antibiotics are ineffective against viruses and viral infections such as the common cold or flu. People are reluctant to change their views and take advice from pharmacists because they think doctors are the only right persons to give them advice and medication.

2. Lack of initiatives and policies: The need for more initiatives from the government and  stakeholders to establish AMS is another problem. Hospital authorities and doctors show negligence in following standard guidelines. 

In most hospitals, there are no antibiograms. Doctors prescribe antimicrobials based on their empirical experiences and sometimes prescribe high doses of powerful antibiotics for the fast recovery of their patients. Without a national policy and relevant practice guidelines, it is difficult to change the scenario.  

3. Worse socio-economic condition: Another challenge is poor socioeconomic  circumstances. The inappropriate use of antibiotics is higher among people with lower levels of education and lower to middle-income groups. 

Many of our patients cannot afford to buy medication at full price, so they only purchase incomplete doses. In fact, many of our people use antibiotics based on their previous history without visiting any physician because this may create a financial burden for them.

4. Lack of proper training for pharmacists: Lack of sufficient training for pharmacists on  AMR is another challenge. As the journey of AMS in Bangladesh is in very preliminary  stages, pharmacists must be adequately trained on different aspects of AMR in various  settings, for example, in communities, hospitals, and retail chemist shops.  

Opportunities are for pharmacists to do more: