Bangladesh is facing a silent but escalating medical emergency as life-saving antibiotics increasingly fail to work on patients who desperately need them. Experts warn that the rampant misuse and overuse of antibiotics in hospitals, pharmacies, and even livestock farming is giving rise to drug-resistant bacteria that threaten to make once-treatable infections deadly again.
Despite repeated alerts from international health organizations and local scientists, the country continues to lack strong regulatory action, allowing antibiotic resistance to grow into what has been described as a looming “post-antibiotic apocalypse.” A deadly future is coming closer: Doctors caution that if this trajectory continues, common ailments such as colds, fevers, and minor infections could once again become life-threatening. “At one time, antibiotics will not work even for common flu,” warns leading microbiologists. “People will die from minor illnesses.” This is no longer a hypothetical scenario. It is already happening inside Bangladesh’s hospitals.
A recent study by the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) revealed alarming levels of antibiotic resistance in hospital settings, especially in Intensive Care Units (ICUs), where the most vulnerable patients struggle for survival.
Dr Gazi Mohammad Salauddin Mamun, Assistant Scientist of Infection Disease Division at icddr,b, shared grave concerns about the findings during an interview with The Daily Industry.
He explains that commonly used antibiotics, including those prescribed as first-line treatments in public health facilities, are rapidly becoming ineffective. “Our research shows that most of the bacteria infecting ICU patients have already become resistant to antibiotics. For example, ceftriaxone, widely used in government hospitals, is now effective in only 8 percent of ICU cases,” said Dr Mamun. Ceftriaxone once stood as a reliable frontline antibiotic. Today, it is nearly powerless against hospital-acquired infections. Even stronger medications such as meropenem, usually reserved for the most severe cases, are failing to provide protection. These reserve-class antibiotics are considered the last barrier before doctors run out of medical tools. “Due to misuse, meropenem now works in only around 30 percent of ICU cases,” Dr Mamun added.
WHO flags uncontrolled misuse in Bangladesh: According to the World Health Organization (WHO), a country’s antibiotic usage should ideally follow a structured approach. At least 60 percent of prescriptions should be from the “Access” category, which includes first-line antibiotics designed for common infections.
But the situation in Bangladesh has veered far away from that recommendation. WHO’s data shows: Access antibiotics in use: below recommended levels. Watch-group antibiotics (stronger drugs): as high as 63 percent of usage locally. These watch-group medicines are meant for controlled, selective use due to their high risk of escalating resistance.
Dr Mamun points out that children are the most frequent receivers of antibiotics in hospitals, even though many childhood infections are viral in nature and do not require antibiotic treatment at all. “Many pediatric diseases get better without antibiotics. However, they are still widely prescribed,” he noted.
Dangerous bacteria now spreading into communities: Antibiotic-resistant bacteria have traditionally been associated with hospital environments, where high medication exposure can foster resistance. But recent studies show a worrying spillover into everyday community settings. “The belief that resistant bacteria only exist in hospitals has now been proven wrong,” said Dr Mamun. “Research indicates that even newborns and people with no direct hospital contact are carrying these resistant strains.”
Once these bacteria enter households, they can easily infect elderly family members, immunocompromised individuals, and young children. The icddr,b study suggests that simple hygiene practices, particularly proper handwashing and maintaining cleanliness in hospitals, can significantly curb the spread. Yet compliance remains low in many healthcare facilities.
Over-prescription and commercial motives worsen the crisis: Experts also say that prescriber behavior is fueling the resistance epidemic. Dr Md Fazle Rabbi Chowdhury, Associate Professor, Internal Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), criticizes the reckless prescription of antibiotics that should only be used in the most critical situations. “Some antibiotics are reserved as the very last line of defense. WHO advises us not to use these unless absolutely necessary,” he emphasized. But the real scenario tells a different story.
“We are seeing frequent use of these reserve-group drugs. Medications meant only for ICU emergency patients are now being widely used even in general wards.” He also blamed the unregulated use of antibiotics in livestock farms, particularly in poultry and cattle rearing, which accelerates resistance that can transfer to humans through food chains and the environment.
A free-for-all in pharmacies: Pharmaceutical misuse outside hospitals is equally dangerous. Dr Lutful Kabir, Professor at Dhaka University’s Department of Pharmaceutical Technology, said the scale of irrational drug use is now “frightening.” “Some unethical doctors prescribe multiple antibiotics from different companies only to please pharmaceutical representatives,” he told Bangladesh Pratidin.
Many pharmacies routinely sell antibiotics without prescriptions, letting patients self-medicate improperly. Meanwhile, consumers often discontinue doses once they start to feel better, giving bacteria a fresh opportunity to mutate and survive. “Because patients do not complete their antibiotic course, resistance grows much faster,” said Dr Kabir. He warned of catastrophic consequences if reserve-class antibiotics continue to be wasted: “We have to remember, once we lose these reserve antibiotics, there is no fallback option. Antibiotics will stop working for even the simplest infections, and we will start losing lives to minor ailments.”
A public health emergency hiding in plain sight: Antibiotic resistance is not a gradual crisis but a rapidly accelerating one. The stakes are high: More costly treatment failures. Higher hospitals stay duration. Increased mortality from everyday infections. otential collapse of modern surgery and ICU care.
Major surgeries, organ transplants, cancer treatments, and even childbirth rely on effective antibiotics to prevent fatal infections. If resistance continues to mount, Bangladesh could witness what WHO calls “a return to the pre-antibiotic era.”
What needs to change: Public health experts say the situation is reversible only if immediate and coordinated action is taken. Key priorities include: Strict regulation of antibiotic sales, Mandatory prescription control in pharmacies, Training doctors on rational prescribing, Improved diagnostic testing before prescribing, Reducing antibiotic use in livestock and agriculture, Public awareness campaigns on completing dosage, Strengthening infection control in hospitals, Investment in research and surveillance. Moreover, hand hygiene and sanitation improvements remain the simplest yet most powerful tools.
Awareness is the first vaccine: Bangladesh stands at a crossroads. On one path lies a future where medical miracles continue to save millions of lives. On the other lies a dark age where routine infections become untreatable and the healthcare system collapses under the weight of preventable deaths.
