Potential reason behind Antibiotic Resistance in Bangladesh and some recommendations to reduce AMR prevalence are illustrated in this presentation. The presentation is prohibited to use as own presentation.

1. Potential reason behind
AMR and Risks in
Bangladesh
Md. Mehedi Hasan | HSS | EDM | Bangladesh www.searo.who.int/bangladesh
MD. MEHEDI HASAN
National Consultant- Essential Drugs and Medicines
World Health Organization (WHO) Bangladesh
12 November’ 2018

2.  Biggest threats to global health, food security, and development
today.
 Affect anyone, of any age, in any country.
 Occurs naturally.
 A growing number of infections are being untreatable as the
antibiotics used to treat them become less effective.
 Antibiotic resistance leads to longer hospital stays, higher
medical costs and increased mortality.
 Increasing health expenditure
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Key facts of AMR

3. 1. Irrational prescription for human and animal
2. Misdiagnosis of disease
3. Misuse of antibiotics in humans and animals by people
4. Sharing of unused antibiotics
5. Lack of counseling and awareness
6. Low quality antibiotics by potency, dissolution, stability etc.
7. Lack of proper storage of Antibiotics.
8. Low quality packaging of antibiotics.
9. Frequent use of antibiotics in animal health care
10. Unconscious disposal of unused antibiotics.
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Potential Reason behind AMR
| Potential reason behind AMR and Risks in Bangladesh

4. 1. Policy Maker (MOHFW, DOE, LGED, DGDA, DGHS, DLS)
2. Antibiotic Manufacturer
A. Raw material manufacturer
B. Finished medicine manufacturer
1. Health Care Professional (Doctor, Nurse, Pharmacist)
2. Retail pharmacy
3. Antibiotic user (General Public)
4. Regulator (DGDA)
5. Education Institute
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Who are responsible for AMR
| Potential reason behind AMR and Risks in Bangladesh

5. 1. Policy to control irrational prescription due to potential
conflict of interest with prescription generation.
2. Policy to control unethical pharmaceutical promotion.
3. Policy to control prescription diagnostic test reagent,
equipment and expertise.
4. Policy to control depot, distribution center and retail
pharmacy.
5. Policy for overall health education instead of physical
education in school level.
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How policy makers are responsible?
| Potential reason behind AMR and Risks in Bangladesh

6. 1. Prescription generation with INN name by physician.
2. Quality evidence based medicine selection among hundreds
of marketed generics by graduate pharmacist.
3. Two step medicine prescription will promote accountability.
4. Evidence generation, ADR reporting by pharmacist
5. Regulation of diagnostic centers facilities, equipment's,
reagents and expertise.
6. Controlling permission to sale specific medicines by specific
category of retail pharmacy.
7. Inclusion of health education instead of physical education in
school level.
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Recommendations to change

7. 1. Manufacturing & marketing unregistered SF product
2. Lack of preclinical, clinical & development studies
3. Formulation problem whereas products quality parameters
are not matched with innovator products (RLD).
4. Weak GMP & quick production
5. Low quality API & Excipients for more profit
6. Low quality packaging
7. Improper distribution and storage
8. Discriminatory price competition and business promotion
9. Ethical marketing
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How manufacturers are responsible?

8. 1. Valid registration and marketing authorization of product
2. Continuous research
3. Appropriate formulation development
4. Proper GMP
5. Quality sourcing of API & Excipients
6. Good Packaging
7. Good distribution ensuring transportation and storage
8. Affordable pricing
9. Ethical marketing
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Recommendations to change

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How Health care professionals are
responsible?
1. Misdiagnosis
2. Deliberate investigation being influenced by diagnostic
center.
3. Lack of concentration to patients notice
4. Writing medicine name being influenced by pharmaceutical
company
5. Difficult accessibility of patients to physician
6. Lack of interest for patient counseling.
7. Lack of interest for collecting patients feedback like ADR
reporting.
8. Expecting prompt response that’s a matter of good
reputation of physician.

10. 1. Concentration to patients notice and history.
2. Motivation of physician for suggesting proper investigation.
3. Writing medicines INN name (not trade name) by physician.
4. Use of low cost resource for better patient counseling.
5. Enhancing patients accessibility to hear their notice.
6. ADR reporting and evidence based data collection.
7. Not to promote prompt response, better promote
counselling.
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Recommendations to change

11. 1. Procurement of medicine currently not based on quality
evaluation rather now its 1st priority is investment profit ratio.
2. Inventory management of medicine not available.
3. Proper storage condition are not recorded in most of the retail
pharmacy.
4. Lack of established medicine disposal system.
5. Dispensing medicine without prescription of registered health
care professionals.
6. Lack of patients oriented responsibility.
7. Lack of patient counseling system.
8. Lack pharmacy practice knowledge.
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Source: General observation in Bangladesh
How retail pharmacy are responsible?

12. 1. Quality evaluation system should be in exist for procurement
and supply of medicine.
2. Inventory management should be followed by proper
guideline.
3. Proper storage condition should be maintained in all
pharmacy.
4. Expired and SF medicine disposal system should be well
established.
5. Not to dispense medicine without prescription of registered
health care professional.
6. Need more awareness building.
7. Establishment of community pharmacy, hospital pharmacy
and clinical pharmacy.
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Recommendations to change

13. 1. Health care seeking behavior e.g prompt relief expectation.
2. Lack of knowledge and practice for health and hygiene.
3. Environmental pollution.
4. Treatment discontinuation when feeling better for
negligence, financial issue or accessibility.
5. Sharing medicine discussing their symptoms each other.
6. Disposal of unused medicine in the environment.
7.
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How public are responsible?

14. 1. Health care seeking behavior should be changed.
2. Awareness about practice for health and hygiene.
3. Awareness & motivation to prevent environmental pollution.
4. Counseling for continuation of medicine dose.
5. Counseling not to share medicine just discussing each
other.
6. Community based drug take away policy and system should
be established.
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Recommendations to change

15. 1. Regulation of 115,186 pharmacy, about 858 manufacturers,
42,398 products, Medical device, Raw Material, Import,
export is very difficult to manage by existing human
resource.
2. New drug act yet not approved.
3. Pharmacovigilance system yet not well established in each
and every hospital, pharmacy and pharmaceutical industry
in collaboration with DGDA.
4. Lack of proper clinical and non-clinical evaluation of product
during registration.
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Source: http://www.dgda.gov.bd/
How regulators are being responsible

16. 1. Approval for manufacturing of Antibiotics in specific classes of
facilities that are maintaining proper GMP.
2. Regulation to ensure sourcing of High quality API & excipients.
3. Active pharmacovigilance countrywide.
4. Registration of antibiotics complying potency, dissolution profile
and bio-equivalence.
5. Control of post marketing variation of medicines.
6. Control of total inventory of antibiotics in pharmacy.
7. Up gradation of model pharmacy initiative.
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Recommendations to change

17. 1. Lack of proper health education system in school level.
2. In school there have a mandatory subject physical
education but no essential health education.
3. Lack of school health campaign.
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How education system is responsible?

18. 1. Physical education should be a part of health education.
2. Health education should be a mandatory subject in school level.
3. School Health campaign.
4. Community based health education program.
5. Health education in hospital and family planning center.
6. Health education in Madrasha and Mosque.
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Recommendations to change

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Overall outcomes
Medicine
Health Care
Life
expectancy
Life Security
Less Out of
Pocket Exp.
Decreased
MMR
Decreased
IMR
Economic
Growth

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Way forward
Taskforce formation
New policy development
Resource utilization
Development of Hospital & Pharmacy Care
Industrial regulation and research for new antibiotics
Education System focusing health and hygiene
Combined Strategic Plan
Combat AMR
Good Animal Health Care, & Food safety
Environmental sanitation & Biosafety

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