Potential strategies to reduce inappropriate prescribing and dispensing of antimicrobials in Bangladesh building on the experiences in other developing countries

In our previous editorial, we discussed that antimicrobial resistance (AMR) is a growing problem world-wide increasing morbidity, mortality and costs1-3. This needs to be urgently addressed with the World Bank recently documenting that the costs associated with AMR could exceed US$1 trillion annually after 2030, and potentially up to US$3.4 trillion annually, unless activities are instigated across countries to improve the prescribing and dispensing of antibiotics4. This is equivalent to 3.8% of annual Gross Domestic Product (GDP)4, with the costs associated with AMR typically greatly exceeding the costs of any antibiotic prescribed or dispensed5. We are aware that mortality rates from AMR are likely to be greatest among low- and middle-income countries (LMICs), including Asian countries such as Bangladesh by 2050, which is a concern going forward6,7. This builds on considerable resistance already to commonly prescribed antibiotics among LMICs including Bangladesh, with AMR rates continuing to rise2,8-15 enhanced by appreciable usage in animal and food production alongside humans16-18. In their recent study, Ara et al. (2021) found high rates of resistance to colistin as well as amoxicillin/clavulanic acid and the cephalosporins in isolates of women attending out-patient clinics for urinary tract infections9. This needs to be urgently addressed.