Human Antimicrobial Use in Bangladesh: Five-Year Trend Analysis Including COVID-19 Pandemic Era

Area of Science:

• * Public Health
• * Infectious Diseases
• * Pharmacology

Background:

• * First national analysis of antimicrobial use (AMU) in Bangladesh (2019-2023).
• * Examines biannual trends and the impact of the COVID-19 pandemic on AMU.

Purpose of the Study:

• * To analyze national antimicrobial consumption patterns in Bangladesh.
• * To assess the influence of the COVID-19 pandemic on antimicrobial prescribing.
• * To inform strategies for antimicrobial stewardship and combatting antimicrobial resistance (AMR).

Main Methods:

• * Antimicrobial use (AMU) analysis using WHO Anatomical Therapeutic Chemical (ATC) classification and defined daily doses (DDD) per 1000 inhabitants per day.
• * Data collected on antimicrobial medicines dispatched from manufacturers.
• * Categorization of antimicrobials based on WHO's Access, Watch, and Reserve (AWaRe) classification.

Main Results:

• * AMU increased from 2021-2022, decreasing in 2023. Cefixime and azithromycin were most consumed.
• * Majority of antibiotics used are broad-spectrum 'Watch'-category drugs (50-67% oral, 70-91% parenteral).
• * AMU significantly rose during the COVID-19 pandemic, particularly systemic antibacterials.

Conclusions:

• * Reducing 'Watch'-group antibiotic use (e.g., cefixime, azithromycin) is crucial to meet the 2030 global target of 70% 'Access' antibiotic use.
• * Strengthening stewardship programs and eliminating self-medication are key strategies.
• * Findings provide essential data for policymakers to address AMR in Bangladesh.