Antibiotic resistance highest among people under 20

Infographics: TBS

Antibiotic resistance is on the rise among children and youth in Bangladesh, posing a serious health concern, as people under 20 have been found to have the highest resistance to antibiotics.

In a recent study by the Department of Microbiology at the National Institute of Laboratory Medicine and Referral Centre, 29.2% of these young people had multiple antibiotic resistance.

Experts say the primary cause of antibiotic resistance stems from improper antibiotic usage, such as taking antibiotics without a prescription, using them without considering culture sensitivity, and unnecessarily prescribing them for conditions like viral fevers.

Additionally, poultry chickens could also be a source of high antibiotic resistance, especially among children who consume poultry meat, they said.

Drug or antimicrobial resistance occurs when bacteria, viruses or fungi evolve over time and ultimately stop responding to the treatments that once killed them, making infections harder to treat.

The study reveals that 8.61% of bacteria in the country have become 100% resistant to all types of antibiotics. The most common of these bacteria are Pseudomonas (25.41%), Klebsiella (21.14%) and E coli (21.04%).

Dr Sunzida Arina, assistant professor at the Department of Microbiology of the National Institute of Laboratory Medicine & Referral Centre, and co-principal investigator of the study, said, "We have found multiple antibiotic resistance in babies as young as a few months and in children up to two years old. This is a concern because it may make it difficult to treat them later in life if they get sick with an infection that is resistant to antibiotics."

For the study, 13,350 samples of clinically suspected cases of infectious diseases from the National Institute of Laboratory Medicine & Referral Centre, eight government medical colleges and three other national institutes were collected from October 2022 to May 2023.

Patients of all ages and both sexes were included in this study. The highest 29.2% of multidrug-resistant organisms among people who were part of the study were less than 20 years of age, followed by those with 20-40 years (28.4%), 40-60 years (24.5%), and less than 60 years (17.9%).

According to the study, 71.8% of patients gave a history of antibiotic intake before this study and 28.2% had no history of antibiotic intake. Among them, 44.1% had a history of antibiotic intake with prescription among indoor admitted patients and outpatient departments and 38.76% had history of taking antibiotics without prescription.

The risks

According to the World Health Organisation (WHO), antibiotic resistance leads to increased mortality, longer hospital stays and higher medical costs.

A six-year-old girl from Brahmanbaria was diagnosed with a urinary tract infection (UTI) and was found to be resistant to 12 out of 15 antibiotics.

Doctors say this could have a dangerous impact on the child's ability to recover from future illnesses, as she may not respond to antibiotics. For example, if she gets another UTI or any other illness in the future, the three antibiotics to which she is still sensitive might also become resistant.

Dr Sayedur Rahman, vice-chairman of the Bangladesh Chapter of the Global Antibiotic Resistance Partnership, said, "The situation of antibiotic resistance is deteriorating. While it may be too late to completely halt its progression, a combination of various interventions can help mitigate further damage."

He also highlighted the issue of children contracting hospital-acquired infections during their hospital stays. He pointed out the lack of significant initiatives for infection prevention in government hospitals.

"Despite the requirement for antibiotic packets to be red in colour and a fine of Tk20,000 for the sale of antibiotics without a prescription, there appears to be inadequate enforcement of these regulations," he said.

Sayedur Rahman, who is also chairman of the Department of Pharmacology at Bangabandhu Sheikh Mujib Medical University, said that doctors should prescribe antibiotics only after testing for sensitivity. To achieve this, the laboratory network needs to be expanded, with labs set up in at least 8-10 districts, if not all 64.

"These labs should test at least 15 samples from hospital patients, chickens, and fish from the upazila and district levels. If this is not done, the problem of antibiotic resistance will not be solved."

Dr Sunzida Arina emphasised addressing the environmental and industrial sources of antibiotic resistance to control the worsening situation.

She said, "The discussion on antibiotic resistance is currently centred within the healthcare sector, but we must extend our control efforts to include the poultry industry and the environment, where antibiotics are extensively used.

"Antibiotics are fed to poultry chickens, raising concerns about the potential development of resistance among consumers, especially children who consume poultry meat. However, a separate study is needed to thoroughly investigate this aspect.