Misuse and development of resistance towards
antibiotics: A survey among 1000 patients in
Gopalganj district in Bangladesh
Md. Roich Khan, Md. Rakib Hossain, Mostafa Al Amin, Shams Ara Khan and Muhammad Torequl Islam*
Department of Pharmacy, Life Science Faculty, Bangabandhu Sheikh Mujibur Rahman Science & Technology
University, Gopalganj, Bangladesh
Muhammad Torequl Islam, Department of Pharmacy, Life Science Faculty, Bangabandhu Sheikh Mujibur Rahman
Science & Technology University, Gopalganj, Bangladesh, E-mail:
Received: August 7, 2018; Accepted: August 17, 2018; Published: August 20, 2018
Torequl Islam Md, Roich Khan Md, Mostafa AA, et al.(2018) Misuse and development of resistance towards antibiotics: A survey among 1000 patients in Gopalganj district in Bangladesh. J Adv Res Biotech 3(2):1-3. DOI: http://dx.doi.org/10.15226/2475-4714/3/2/00136
The current study was done to view the level of knowledge about
antibiotic misuse and the development of antibiotic resistance among
the general people in the District Gopalganj, Bangladesh. For this
purpose, questionnaires were prepared and distributed randomly
among 1000 abusers within the age range 15 to 80 years. To get
appropriate responses, some literate volunteers were assigned who
directly collected data. Results suggest that males were more misusers
than the females. Second generation antibiotics are the frequently
used antibiotics among the patients. More patients were found
using antibiotics without clinical diagnosis and in an incomplete
dose fashion. More studies are necessary to find out the actual facts
on antibiotic misusages and the subsequent gaining of antibiotic
Key words: Antibiotics; Misuse; Resistance; Health care.
Antibiotics of various origins are used in the treatment of
bacterial infections (NHS, 2015). However, resistance towards
antibiotic drugs is a common occurrence worldwide. Numerous
internal and external facts are involved in the development of
antibiotic resistance (CDC, 2017). Misuse of antibiotics and
growing resistance to these kinds of medications was also seen by
Clark et al. (2000). In Jordan, the self antibiotic taking behavior of
the patients and growing resistance was reported by Al-Azzam et
al. (2007). Similar studies in different regions in the world were
also seen by Barah and Gonçalves (2010), Basnyat et al. (2015),
and Chem et al. (2018).
Bangladesh is one of the densely populated countries in
the world. Gopalganj (Map), a district in the Dhaka division of
Bangladesh has about 1,172,415 civilians. Its total land area is
, where 800 people live per square kilometer
Figure 1: The quality of drinking water is not so good in most of the regions of this district. Therefore, waterborne diseases, especially pathogenic bacterial infectious frequently occur among the people, leading to take antibiotics on a regular basis. Furthermore, patients with other disease conditions also experience in various groups of antibiotics.
We performed a survey on the misuse of antibiotics among 1000 patients in Gopalganj district, aiming to understand the antibiotic usage fact of developing
antibiotic resistance among them.
Materials and methods
Study design & questionnaire
A retrospective and cross-sectional survey was designed to
assess the misuse of antibiotics and associated development of
antibiotic resistance. A questionnaire was developed, regarding to
antibiotic consumption and associated complications among the
people. A signed consent form for this study was provided by the
Department of Pharmacy, Bangabandhu Sheikh Mujibur Rahman
Science and Technology University, Gopalganj-8100, Bangladesh
was disclosed to the willingly participated patients and medical
practitioners, which was served as an ethical consideration.
Population, age, area and time
Data were collected from 1000 people, age between 15 to 80
years in Gopalganj district, Bangladesh during January to April,
2018. Both in-patients and out-patients in different hospitals,
clinics and some medical college and hospitals were selected in
Data collection and statistical analysis
From the willing patients, we collected primary data. These
data were then analyzed by using Microsoft Excel 2007 and
GraphPad Prism (version 6.5).
Table 1 suggests that common cold, cough, fever, and gastric
ulceration are frequently occurring diseases among the sample
patients. However, urinary tract infection (UTI), diarrhea,
appendicitis, and asthma were also prominent.
Table 1: Observed diseases among the patients (n = 1000)
Allergy, skin rash and itching
Arthritis and joint pain
Cold, cough and other related diseases
Cardiovascular (CVS) diseases
Jaundice and lever diseases
Urinary tract infection (UTI)
Among the antibiotic misusers, 55% were male patients.
Most of the antibiotic prescribers were the Bachelor of Medicine
and Bachelor of Surgery (MBBS) doctor (58%), which is then
followed by self-medication (15.74%), quack (15.23%) and
Bachelor of Dental Surgery (BDS) (11.16%). According to Graph
1, cephalosporin and penicillin users were more prominent than
the other groups of antibiotics.
Third generation antibiotics were seen in the patients than
the 2nd, 4th and 1st generation (Graph 2) 75% patients were found
to use antibiotics without clinical diagnosis test report. On the
other hand, 77% patients were seen to take antibiotics in an
Graph 1: Commonly used antibiotics by the patients
Graph 2: Used antibiotic generations among the patients
Antibiotics reduce the burden of common infectious diseases
and become essential for many medical interventions. Antibiotic
resistance, a specific type of drug resistance is the ability of a
microorganism to withstand the effects of an antibiotic. The
loss of efficacy against common pathogens has not only led to
a shift towards more expensive antibiotic drugs in high-income
countries, but also to increased morbidity and mortality in lowincome
and middle-income countries .
Therefore, identification of spatial and temporal trends
in antibiotic consumption is important to understand the
epidemiology of antibiotic resistance. First, identification of
regions in which rate of consumption of antibiotics per person is
high or rising can rapidly predict where the threat of new resistant
infections will be greatest and can help to inform initiatives to
preserve antibiotic efficacy . Second, the mapping of the
distribution of antibiotic consumption provides a baseline for
the assessment of efforts for the future antibiotic drug reduction
The rationale for educating the public is that knowledge
about antibiotic treatment and awareness of antibiotic resistance
are thought to influence patient and parent demand for antibiotic
prescribing . As irrational drug use not only poses a health
hazard to the individual and the society, but it also has a variety of
medical, economic and social impacts. On the other hand, rational
drug use promotes cost-effective therapy and quality of care.
In this study, irregular usage, usage without diagnozed
situations, self-prescribing behavior of the patients, and dose
incomplete were seen among the patients.
A number of facts have been seen from the misuse and the
development of antibiotic resistance among the patients in
Gopalganj district, Bangladesh. Adequate precautions should be
taken by the local government and prescribers to manage the
We are grateful to all the patients, physicians, authority of
the hospitals & clinics, diagnostic centers, and finally to the
Bangabandhu Sheikh Mujibur Rahman Science and Technology
University (BSMRSTU), Gopalganj-8100, Bangladesh for the
permission and providing facilities to conduct this study.
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