Irrational Use of Antibiotics and Antibiotic Resistance in Southern Rural Bangladesh: Perspectives from Both the Physicians and Patients

Aims: Antibiotic resistance is one of the widely recognized public health challenges in Bangladesh. The present study was aimed to analyze the current status of irrational use of antibiotics in rural Bangladesh and to explore the views from both physicians’ and patients’ perspective.
Study Design: Population based survey.
Place and Duration of Study: The survey was conducted among 6,000 patients and 580 physicians in the rural areas of Dhaka and Rajshahi divisions of Bangladesh from July 2012 to December 2012.
Methodology: The survey followed a face-to-face interview protocol. 24 Upazila Health Complexes and 112 Union Health Centers of Dhaka and Rajshahi divisions were conveniently surveyed by trained volunteer interviewers. Two separate survey questionnaires were developed for physician and patient survey.
Results: From the physician survey it was found that significantly more doctors prescribe antibiotics in suspected infections (P<.0001). Around forty-four (44.1) percent doctors prescribe antibiotics in cold and fever before diagnosis. A significant proportion of physicians never receive any feedback about the antibiotic they prescribe (31.9%, P<.0001) and more than 50% doctors claimed that they receive feedback occasionally, not always (P<.0001). According to the physician’s patient non-compliance is the main cause of antibiotic resistance in the country (68.8%). Though 48.6% patients think that it is important to strictly follow the doctor’s prescription, a significant percentage believe that it is not always necessary (26.7%, P<.0001) and more than 50% patient stop taking the antibiotic as soon as the symptoms disappear, while only 25.2% patient complete their full course. Only 6.3% patients consult their doctor if they miss the dose of an antibiotic and more than 50% take the next dose on time (P<.0001). When a drug does not work the patient usually consider the doctor is incompetent (25.6%) and many (24.5%) believe that the quality of the drug is not up to the mark.
Conclusion: The result of this survey indicates that the antibiotics are used among the rural people in irrational way. To overcome this situation close supervision of the relevant authority is required in order to minimize the growing antibiotic resistance in Bangladesh.