icddr,b study highlights need for more effective antibiotic stewardship in the country

Antibiotic resistance refers to the ability of certain bacteria to survive or grow in the presence of antimicrobial compounds — or antibiotics — that are typically lethal to bacteria. Resistant pathogenic bacteria now represent a major global public health burden and challenge, contributing to millions of deaths every year.

The evolution of antibiotic resistance in bacteria is tightly linked to inappropriate and often unnecessary use of antibiotics in humans and agricultural livestock, which increases the likelihood of spread of bacteria containing resistant genetic variants. Self-medication and misuse — for instance, to treat viral infections — of antibiotics are common in Bangladesh and many other countries. In addition, post-COVID-19 opportunistic bacterial infections, as well as embedded misunderstandings of how antibiotics function have led to even greater use and misuse during the pandemic, creating more favorable conditions for the emergence of antibiotic resistance.

To minimize the likelihood of the emerge and spread of antibiotic resistance, the WHO recommends antibiotic stewardship interventions that promote judicious use of antibiotics. To help support such interventions, the WHO developed the AWaRe (Access, Watch, and Reserve) classification system for antibiotics. All current antibiotic classifications are available here. icddr,b scientists recently led a study on the pattern of use of different antibiotic groups across four government hospitals from two administrative divisions in Bangladesh.

The Access group antibiotics (48 antibiotics in total) represent the first and second choices of recommended treatments for common infections. These antibiotics — which include ampicillin, amoxicillin, gentamicin etc. — have lower resistance potential based on currently known levels of global resistance against them. The Watch group antibiotics (110 antibiotics in total) have higher resistance potential compared to the Access group and include azithromycin, cefixime, ceftriaxone etc. The Reserve group antibiotics (22 antibiotics in total) are composed of newer generation antibiotics that should be used as last-resort interventions when other alternatives have failed. The AWaRe classification system was developed to promote the use of Access group antibiotics — to at least 60% at the country level — and decrease the use of Watch and Reserve group antibiotics.

The current study found that across recorded cases of antibiotic use in the hospital wards between February and April 2021, 64% comprised Watch group antibiotics while only 35.6% were Access group ­— essentially the inverse of WHO-recommended proportions to help curb antibiotic resistance. These findings point to an urgent need to develop a nationwide antibiotic stewardship program for physicians to provide training on strategies for antibiotic resistance management, including the WHO-recommended guidelines for the antibiotics from different AWaRe groups.

“Future studies that include more hospitals, both government and private, perhaps from all administrative divisions in Bangladesh, may provide a more precise understanding of antibiotic use patterns at national level,” noted Dr. Fahmida Chowdhury, Associate Scientist at icddr,b and principal investigator of the study. “But these findings do reveal an alarming trend in the use of antibiotics with high resistance potential and should spur immediate action toward more data collection and education on antibiotic stewardship.”


Ornob Alam