I read icddr,b’s (the acronym for the famous International Centre for Diarrhoeal Disease Research, Bangladesh) blog post recently about their ongoing work on antimicrobial resistance. The work is impressive and very relevant to the situation in that country, and the post also brought back memories of a time 6 years ago when I was in Bangladesh courtesy of ReACT.
Our local hosts had driven us out to a typical village in Chakaria (Cox’s Bazar District). The trip had taken a couple of hours along barely serviceable roads – in fact, one of the cars was stuck in the mud and we could only extricate it thanks to helpful villagers nearby – and there were clearly no doctors (MD’s) in the vicinity for miles, but the village pharmacies were stocked with the latest generic medications including powerful antibiotics such as levofloxacin which could be purchased off the shelf. Most people living in such villages typically get their medications directly from the pharmacies (in certain situations just a convenience store) or from a village doctor who is usually not formally trained in modern medicine.
It is important to understand that there is a bit of a Catch-22 situation here and in many parts of Asia. Excessive antibiotic prescription (including over-the-counter purchases) contributes to antimicrobial resistance, with eventual mortality and economic costs. But at the same time, lack of access to antibiotics is immediately life- or livelihood-threatening to many who live in more remote parts of countries where healthcare systems are already overstretched. Preventing the sale of over-the-counter antibiotics is only possible when access to antibiotics has improved in many countries.