Although antibiotics are effective against bacterial infections, consuming antibiotics too frequently can leave a harmful effect on a patient’s health. The Cabinet has, therefore, imposed restriction earlier this week on selling antibiotic drugs in the medicine stores – thereby giving its final approval to the draft of ‘Drugs and Cosmetics Act 2023’.
Once the draft law is endorsed in the Parliament and assented by the President, the sale of antibiotic drugs without prescription from a registered doctor would be banned. It would be mandatory to have a prescription by any registered physician to sell the antibiotic medicine, which is considered to be hazardous for health.
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The approval was given in the weekly Cabinet meeting chaired by Prime Minister Sheikh Hasina at her Tejgaon office in Dhaka. With the commendable move taken to stop sale of antibiotics without prescription, many from among the concerned section of the society are pondering as to how this latest initiative will help curb misuse and overuse of antibiotics.
Why are antibiotics used?
Antibiotics are one of the most often prescribed medications worldwide. They are used to treat a range of bacterial infections. Most people only take antibiotics for a week or two at a time. However, some may take antibiotics for a longer time to treat long-term conditions like acne or pneumonia.
But antibiotics are inadequate against viruses. Most upper respiratory tract illnesses, such as the common cold and influenza, are caused by viruses. Antibodies are, thus, ineffective against these viruses.
The overuse of antibiotics
Antibiotics can be lifesaving, but their long-term use has a number of risks, including the development of antibiotic-resistant bacteria. Antibiotic resistance can also occur when antibiotics are overused or used improperly. It implies that the next time someone contracts the same infection, the bacteria can change to become resistant to the same antibiotic, which can lead to the need for more severe medications in the future. In addition, as the immune system weakens, the chance of infection increases.
Statistically, the overuse of antibiotics worsens each year. This overuse is a result of everyone desiring a quick fix rather than improving their immune system naturally, which is the ideal method for reducing illnesses. Antibiotics are typically provided in the meantime for bacterial infections when lab results may take several days to come.
Antibiotics should not be taken for no reason or just to observe what happens. A patient must have a verified bacterial illness in order to use an antibiotic appropriately. Long-term damage can be permanent for some people.
Gut flora upset:
Gut flora refers to the bacteria that help in maintaining the gut’s balance and ensure optimal digestion and immunity. Antibiotics can upset the balance of bacteria in the gut and kill a lot of these bacteria, which can lead to a variety of health issues.
Cognitive decline in women:
A recent study found that middle-aged women who consume antibiotics for a long time are more likely to lose their cognition. The study indicated that women who had previously taken long-term antibiotics performed lower on measures of learning, working memory, motor speed, and attention compared to women who had never consumed antibiotics long time.
While antibiotics are designed to eliminate harmful bacteria, they frequently eliminate beneficial bacteria that protect against fungal infections. People who use antibiotics frequently get fungal infections in the mouth, throat, and genitals.
Antibiotics can potentially interact with many other medications and reduce their anti-disease efficacy. These combinations may also exacerbate the adverse effects of the other medication or antibiotics. Some antibiotics induce severe liver enzymes, which can increase or decrease the effectiveness of some antibiotics, cardiac drugs, antiepileptic meds, and combination drugs.
When antibiotics are used often, bacteria try to change their structure or release certain enzymes to stay alive. This makes bacteria resistant to the antibiotics that were once used to treat patients. For instance, an antibiotic that was once utilized to treat typhoid, fever, and respiratory infections would no longer be effective. Previously, diseases such as tuberculosis required just 3- 4 medications for 6 months, but now, due to resistance, they require 9- 11 drugs for 1.5- 2 years.
The Global Research on Antimicrobial Resistance reported that antimicrobial-resistant bacteria were directly responsible for 1.27 million deaths in 2019. According to the report, antibiotic resistance could cause 10 million deaths annually by 2050.
And the move to ban selling of antibiotics sans prescription
On February 6, the government gave its final nod to the draft of the Drugs and Cosmetics Act 2023, which prohibits the sale of antibiotics without a prescription from a licensed physician. “As per the draft law, the antibiotic drugs can’t be sold without the prescription of any registered doctor and it’ll be a punishable offense,” stated Cabinet Secretary Md Mahbub Hossain after the meeting. “The shopper will be fined Tk 20,000 if the antibiotic medicine is sold without a prescription”, he said.
As the prevention of antimicrobial resistance (AMR) has arisen as a major concern, the cabinet secretary stated that monitoring and restricting the use of antibiotics were included in the proposed law. There are now two drug laws: The Drugs Act of 1940 and the Drugs (Control) Ordinance of 1982.
“In the proposed law, some 30 types of offenses were cited and the maximum punishment would be life-term imprisonment for several offenses like the production of fake and adulterated drugs as well as creating an artificial crisis of drugs,” the cabinet secretary added. Some new issues, such as the creation of medicines, vaccines, and medical devices, have been added to the draft law, he said, adding that the WHO’s standards must be followed in the case of the drug issue.
A much-needed step for Bangladesh
The misuse and overuse of antibiotics have recorded a dramatic rise in Bangladesh in recent years. Self-medication by patients and the desire of pharmacies to profit from the unrestricted sale of antibiotics have increased rapidly. Antibiotics are currently available without a prescription, and many quacks and pharmacy employees prescribe them without a diagnosis. According to Bangabandhu Sheikh Mujib Medical University (BSMMU) pharmacology Professor Md Sayedur Rahman, practically all medications in Bangladesh, including antibiotics, are now readily available over-the-counter (OTC).
In a joint research published in November 2019, the Directorate General of Drug Administration (DGDA) and the World Health Organization found that antibiotics use in Bangladesh had marked an increase by 30.81 percent over the past two years. A laboratory examination conducted by the BSMMU between 2010 and 2018 revealed a significant increase in the number of resistant bacteria in the nation. In 2010, 6.5% of all patients were diagnosed with resistant bacteria and multidrug-resistant germs. Nevertheless, the rate grew to 14% in 2018, according to the study.
There is no accurate data on deaths caused by antibiotic overuse in Bangladesh, but physicians say a significant number of deaths at ICUs are caused by antimicrobial resistance. With the latest move to ban the sales of antibiotics without prescription, no pharmacy or medicine corner can sell antibiotics without an authorised prescription. Public awareness will also be needed to eradicate the unnecessary consumption of antibiotics. Thus, the latest law can help tackle the ongoing challenge of antibiotic misuse and overuse – both.