Antibiotic use in a rural community in Bangladesh

Antibiotic use by 175 000 people in the Matlab rural surveillance area (MSA) of the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) was studied to identify practices which might affect microbial drug resistance. We surveyed a 3% sample of drug purchases from pharmacies in the MSA over a four-week period in August and September 1980. Fifty-seven drug purchases were made per thousand Matlab residents per week; 9% of these were of tetracycline and 26% were antibiotics. Forty-eight per cent of the antibiotic tablets or capsules for persons aged 15 years or more were purchased in quantities which represented less than a single day's dose and rarely was a full course of therapy purchased at one time. The rate of tetracycline purchase for young children--in whom it is usually contraindicated--equalled the rate for older children and young adults. These practices have probably not led to improvements in health and may have promoted the emergence and persistence of drug-resistant micro-organisms. To optimize antibiotic use, control measures at government, producer, prescriber and consumer levels need to be pursued.