ANTIBIOTIC ABUSE IN BANGLADESH: A RESEARCH ON

LEGAL PERSPECTIVE

By
Ahammed Jubaer Chowdhury
ID: LLB 06209609

A Thesis Submitted in Partial Fulfillment of the Requirements for the Degree of LL.B.
(Honours)

Supervised by
Afrin Jessin Jenny
Assistant Professor

December 2020

DEPARTMENT OF LAW

STAMFORD UNIVERSITY BANGLADESH

 ANTIBIOTIC ABUSE IN BANGLADESH: A RESEARCH ON
LEGAL PERSPECTIVE

By
Ahammed Jubaer Chowdhury
ID: LLB 06209609

A Thesis Submitted in Partial Fulfillment of the Requirements for the Degree of LL.B.
(Honours)

Supervised by
Afrin Jessin Jenny
Assistant Professor

December 2020
 LETTER OF TRANSMITTAL
To

Afrin Jessin Jenny

Assistant Professor

Subject: Submission of thesis paper.

Dear Madam,
It is a great pleasure to submit my thesis on ‘Antibiotic Abuse in Bangladesh: A
Research on Legal Perspective’ I have giver best efforts to finish the thesis with
relevant information that I have collected from various sources. I have collected
from various sources. I have concentrated my efforts to achieve to objectives of the
work and hope that my endeavor will serve the purpose. I shall be grateful and
obliged if you kindly accept may thesis and evaluate it.

Sincerely yours,

-------------------------------------

Ahammed Jubaer Chowdhury

ID: LLB 06209609
Department of Law
Stamford University Bangladesh
 CERTIFICATION

This is to certify that the dissertation on ‘Antibiotic Abuse in Bangladesh:

A Research on Legal Perspective’ is done by Ahammed Jubaer Chowdhury,
Batch-
62 A, ID-LL.B 06209609, in partial fulfillment of the requirements for the degree
of LL.B. (Honours) from Stamford University Bangladesh. The dissertation
has been carried out under my guidance and is a record of the bona-fide work
carried out successfully.

-------------------------------

Afrin Jessin Jenny

Assistant Professor
Department of Law
Stamford University Bangladesh.
 DECLARATION

I Ahammed Jubaer Chowdhury, the student of Law, batch-62 A, bearing ID: LL.B
06209609 ‘Antibiotic Abuse in Bangladesh: A Research on Legal
Perspective’ from Stamford University Bangladesh would like to declare here, the
declaration on the dissertation report on ‘Antibiotic Abuse in Bangladesh: A
Research on Legal Perspective’, which I have not submitted for any other degree
before. The work I have presented dose not breach any copyright.
I further undertake to indemnify the university against any loss or damage
arising from breach of the foregoing obligations.

-------------------------------------

Ahammed Jubaer Chowdhury

ID: LLB 06209609
Department of Law
Stamford University Bangladesh
 ACKNOWLEDGEMENTS

At first, I present my due rewards to all mighty, who have provided me with the
valuable opportunity to build and compete this report successfully with
Sincere and sound mind.
I would like to express my gratitude to my supervisor A Afrin
Jessin Jenny, Department of Law for her guidance during the dissertation program.
Her suggestions and comments were really a great source of spirit to make the
report a good one.
Finally, I would like to thanks my parents from the bottom of my heart for
their endless support and encouragement.
 ABSTRACT

Antibiotic resistance (ABR) is a worldwide problem and Bangladesh is a

major contributor to this owing to its poor healthcare standards, along with the
misuse and overuse of antibiotics. The overall goal of antimicrobial
stewardship is to optimize clinical outcomes whilst minimizing the
unintended consequences of antimicrobial use. It is a multifaceted approach that
includes policies, guidelines, education, monitoring and audit. It should not be
seen as a separate issue to that of controlling healthcare associated infections, as
both are required in healthcare institutions, therefore a whole-systems
approach is required. to identify gaps in surveillance, and to provide
recommendations based on the findings.
 TABLE OF CONTENTS
Page No.
Acknowledgements x

Chapter 1
INTRODUCTION 1

Chapter 2
CONCEPT OF ANTIBIOTIC ABUSE
2.1 What is Antibiotic 3
2.2 Antibiotic Abuse 3
2.3 What is Antibiotic Resistance: 3
2.4 Reasons for Developing Antibiotic Resistance: 4
2.5 The Cnsequences of Antibiotic Overuse in Dhaka 4
2.6 Concluding Remark 4

Chapter 3
CURRENT CONDITIONS OF ANTIBIOTIC ABUSE IN BANGLADESH
AND EXISTING LAWS ABOUT ANTIBIOTIC USE
3.1 Current Conditions of Antibiotic Abuse in Banglaesh 6
3.2 Bangladesh Drug Policy, Regulations, Ordinacne and Strategies 7
3.3 Drug Act in Bangladesh: 9
3.4 Import of Drug Act 9
3.5 Export of Drugs Act 9
3.6 Manufacture, Sale and Distribution of Drugs 10
3.7 National Medicine Policy, 2016 11
3.8 Policy and Legislation 11
3.9 Helath Rights Protection 12

8
3.10 Concluding Remark 12

Chapter 4
LEGAL FRAMEWORK RELANTING TO ANTIBIOTIC RESISTANCE
IN VARIOUS COUNTRIES
4.1 Legal Framework and Laws That Enact by India 13
4.2 Legal Framework Made by EU 14

4.3 Legal Framework Made by United States 16

4.4 Concluding Remark 16

Chapter 5
NECESSARY STEPS CAN BE TAKEN 17

Chapter 6
CONCLUSION
6.1 Recommendations 20
6.2 Conclusion 21

REFERENCES 22

9
 Chapter 1
INTRODUCTION

An antibiotics is a type of antimicrobial substane active against becteria and is the

most important type of antibacterial agenet for fighting bacterila infections.
Antibiotic medications are widely used the tretatment and pervention of such
infections. They may either kill or inhibit the grwoth of bacerial . All
limited number of antibiotics are not effective aganist viruses such as the common
cold or influenza; drugs which inhibit viruses are termed antivrial drugs or
antiviral rather than antibiotics.1
Antibiotic resistance is a worldwide problem and Bangladesh is a major
contributor to that owing to its poor healthcare standards, along with the misuse
and overuse of antibiotics. A study conducted by Poribesh Bachao Andolon
(Poba) in 2016 revealed that about 56% of antibiotics prescribed to patients
in Dhaka hardly worked, as germs developed antibiotic resistance due to
their indiscriminate use. Poba collected 305 samples of culture and sensitivity (C
and S) of patients’ samples (cough, urine and blood) from three hospitals in the
capital and tested those at government recognized laboratories to identify the
nature of antibiotic resistance of germs in the human body. The report
revealed that antibiotic resistance has developed in the bodies of most city
residents. Unchecked use of antibiotics in poultry, fish and veterinary feeds, and
their unplanned use in treating diseases contribute to the increase in antibiotic
resistance. Antimicrobial resistance threatens the effective prevention and
treatment of an ever increasing range of infections caused by bacteria, parasites,
viruses and fungi. While treating
patients in recent years we have found that typhoid, urinary infection and

1
[https://www.slideshare.net/chewmeyellow/antibiotic-abuse-and-misuse?qid=12ccc72d-
6a6f- 4fe5-8923-a3d2278132d2&v=&b=&from_search=2, last visited on 25.08.2020].

1
diarrhoea are becoming resistant to most of the medicines available in the market.
The government has failed to take timely action against the deadly
resistance. However, as later is better than never, few initiatives have been taken
in recent times. But the steps need scaling up. Besides, irrational use of
antibiotics in humans, little awareness among people and drug sellers, a
weak surveillance process, and dearth of information about the health
situation of the country are also contributing to the spread of antimicrobial
resistance (AMR) in Bangladesh. People always have a misconception that once
they start taking antibiotics, they are cured, hence, most often do not take
doses regularly. Irrational use of antibiotics in animal feeds, especially in
poultry farms, have scaled up the fear of AMR spreading in the country.
This research s important because antibiotic resistance in very dangerous and
in future it will become the question of our existence. The few steps taken
by government are use in judging reality. It will show us about our
situation and depth of the matter.
The research consists of five main Chapter : first one is Introduction, where
initial discussions have taken place, second one is Concept of Antibiotic
Abuse where the idea of antibiotic abuse, antibiotic resistance and reasons for
developing antibiotic resistance has been given, third one is Current Condition of
Antibiotic Abuse in Bangladesh and existing laws about antibiotic use where
I will try to present the reality of Bangladesh about using antibiotic and try to find
out saying of law about control their situation, fourth one is Legal Framework
Relanting To Antibiotic Resistance In Various Countries where we will try to find out
which steps they have taken to deal with this matter, fifth one is Necessary
Steps can be Taken, where I tried to highlights that what kind of steps can
be taken by the outhority. In the final part Recommendation and Conclusion are
done.
 Chapter 2
CONCEPT OF ANTIBIOTIC ABUSE

2.1 What is Antibiotic

An antibiotics is a type of antimicrobial substane active against becteria and is the
most important type of antibacterial agenet for fighting bacterila infections.
Antibiotic medications are widely used the tretatment and pervention of such
infections. They may either kill or inhibit the grwoth of bacerial . All
limited number of antibiotics are not effective aganist viruses such as the common
cold or influenza; drugs which inhibit viruses are termed antivrial drugs or
antiviral rather than antibiotics.2

2.2 Antibiotic Abuse

Antibiotic abuse, sometimes called antibiotic misue or antibiotic overuse, refers to
the abuse or overuse of antibiotics, with potentially serious effects on helath. It is a
contributing factor to the development of antibiotic reistance, including the
creation of multidrug resitant bacteria, informally called “super bugs”

2.3 What is Antibiotic Resistance:

Antibiotics are medicines used to prevent and treat bacterial infections. Antibiotic
resistance occurs when bacteria change in response to the use of these medicines.
Bacteria, not humans or animals, become antibiotic-resistant. These bacteria may
infect humans and animals, and the infections they cause are harder to treat than
those caused by non-resistant bacteria.Antibiotic resistance happens when the
germs no longer respond to the antibiotics designed to kill them. That means the

2
[https://www.slideshare.net/chewmeyellow/antibiotic-abuse-and-misuse?qid=12ccc72d-
6a6f- 4fe5-8923-a3d2278132d2&v=&b=&from_search=2, last visited on 25.08.2020].
germs are not killed and continue to grow. We can also say that antibiotic
resistance means loss effectiveness of antibiotics or antimicrobial agent.

2.4 Reasons for Developing Antibiotic Resistance:

The use of antibiotics has saved millions of lives, but its pervasive use to treat any
infection, whether serious, minor, or even viral has lead to the increase in
antibiotic resistance. Antibiotics strictly target bacteria, but it is sometimes
difficult to differentiate between viral and bacterial infections without costly tests.
It is often less time-consuming and more cost effective to proactively
prescribe antibiotics, rather than take precautions and prescribe only the correct
treatment
In summary, the main causes of antibiotic resistance have been linkedto:
i. Over-prescription of antibiotics
ii. Inappropriate Prescribing
iii. Patients not finishing the entire antibiotic course
iv. Overuse of antibiotics in livestock and fish farming
v. Poor infection control in health care settings
vi. Poor hygiene and sanitation
vii. Absence of new antibiotics being discovered
viii. Use of antibiotics without prescription

2.5 The Consequences of Antibiotic Overuse in Dhaka

Another recent icddr,b study has found rising antibiotic resistance to
bacterial pathogens which cause bloodstream infectionsa condition when bacterial
infection elsewhere in the body enters the bloodstream.Dr Dilruba Ahmed, head of
clinical microbiology and immunology at icddr,b, has studied over 100,000 blood
samples from a period of over ten years and tested them for the presence of
pathogens and the incidence of antibiotic resistance in these pathogens. A
high percentage of
these bloodstream pathogens have acquired multidrug resistance.3

3
Dr. Asfaque, “Antimicrobial Resistance & Infection Control”, Journal of Antimicrobial
Resistance & Infection Control.Vol. No. 6 (2015), p.5

4
2.6 Concluding Remark
That is the reasons why antibiotic resistance develops, such as over prescription of
antibiotics, inappropriate prescribing, over-use of antibiotics in livestock and fish
farming using of antibiotics. But these are happening due to human negligence. It
is very important to have strict and effective laws to control these, so that these
issues do not happen in any way. Those involved in these issues should ensure the
proper use of antibiotics to protect the interests of ordinary people. But it is seen
that it is not possible due to these negligence Due to which, on the one hand, our
human rights are being violated and on the other hand, public health is
being threatened. Which is why I think there needs to be strict and effective
legislation.
 Chapter 3
CURRENT CONDITIONS OF ANTIBIOTIC ABUSE IN BANGLADESH
AND EXISTING LAWS ABOUT ANTIBIOTIC USE

3.1 Current Conditions of Antibiotic Abuse in Banglaesh

Antibiotic resistance is a worldwide problem and Bangladesh is a
major contributor to that owing to its poor healthcare standards, along with the
misuse and overuse of antibiotics.
In Bangladesh,Antimicrobials are the most commonly prescribed group
of drugs in general practice and in hospitals.A majority of the prescribers in
Bangladesh diagnose infection by clinical assessment and suspect a microbial
4
aetiology .Many developing countries including Bangladesh allow
the dispensation of antibiotics without a prescription; this can lead to self-
medication and dispensation of drugs by untrained people. In one survey
from the Rajbari district, 100 000 doses of antibiotics had been dispensed without
a prescription in one month5.In another study, 92% medications dispensed by
pharmacies were without a prescription6. Although there are restrictions on this,
there are no signs of compliance.
Unethical drug promotion and marketing of substandard and unnecessary
drugs in Bangladesh is not uncommon. A medical practioner can prescribe
any
drug used for the common cold to cancer. Moreover, polypharmacy is very

4
MA. Faiz Rahman ‘MR. Rational antimicrobial Use’, Journal of Chittagong Medical College
Teacher Association, Vol.15 No.1-2, ( 2004), pp.1-3.
5
J. Roy ‘Health Status, Treatment and Drug Use in Rural Bangladesh: A Case Study of
a
Village’ Australian Journal of Rural Health, Vol.5 No.2, (1997), p.70 – 75.
6
SM Ahmed Hossain, ‘Knowledge and Practice of Unqualified and Semi-Qualified
Allopathic Providers in Rural Bangladesh: Implications for the HRH Problem.’ Aritcle
of Health Policy, Vol. No. 84, (2007), pp.332–343.
common among the rural medical practitioners with antibiotics and vitamins
prescribed widely7
Unchecked use of antibiotics in poultry, fish and veterinary feeds are
common in Bangladesh and their unplanned use in treating diseases contribute to
the increase in antibiotic resistance. Antimicrobial resistance threatens
the effective prevention and treatment of an ever increasing range of infections
caused by bacteria, parasites, viruses and fungi.8
Another recent icddr,b study has found rising antibiotic resistance to bacterial
pathogens which cause bloodstream infectionsa condition when bacterial infection
elsewhere in the body enters the bloodstream. Dr Dilruba Ahmed, head of clinical
microbiology and immunology at icddr,b, has studied over 100,000 blood samples
from a period of over ten years and tested them for the presence of pathogens and
the incidence of antibiotic resistance in these pathogens. A high percentage
of these bloodstream pathogens have acquired multidrug resistance.9

3.2 Bangladesh Drug Policy, Regulations, Ordinacne and Strategies

The Government of Bangladesh is committed to provide effective health
care service forthe people of the country as per the constitution of the
People’s Republic of Bangladesh sections 15 (a), 15(d), and 18(1). Good quality
drugs are pre-requisite along with the skilled physicians and standard medical
devices and supplies for promoting improved health care service. Quality and safe
veterinary drugs and vaccines are required to ensure safe food and keep live stocks
healthy
for protection of public health. The pharmaceuticalindustryof Bangladesh is one of
the first growing sectors. Once wherealmost 80% demand of drugs were
imported, currently more than 97% of medicines are being produced in the

7
FR. Chowdhury Rahman, ‘Rationality of Drug Uses: Its Bangladeshi Perspectives’ Journal
of Mymensingh Medical, Vol. 15 No. 2 (2006), p.15
8
[https://www.amr-insights.eu/antibiotic-resistance-crisis-deepens-in-bangladesh/lastvisited
on 11.11.2020].
9
Dr. Asfaque, “Antimicrobial Resistance & Infection Control”, Journal of Antimicrobial
Resistance & Infection Control.Vol. No. 6 (2015), p.5
country. Quality drugs locally produced are now being exported to 113 countries
across the globe, including developed countries. Already, a number of drug
manufacturing companies have been awarded with Good Manufacturing Practice
(GMP) certificates by drug regulatory agencies of developed countries. Due
to attaining required technology, Bangladesh pharmaceutical sector is capable
of producing almost all conventional and high technology based dosage forms.
The pharmaceutical sector is enriched with not only higher technological resources
but also experienced and skilled pharmacists as well as other affiliated
competent manpower. Since 2009, sufficient medicines of required
quality are being supplied in line with expansion of health care
center/facilities.10
The first National Drug Policy was formulated by the Government of
Bangladesh in 1982which was hailed and immensely praised by WHO and other
international organizations. The first National Drug Policy led to ensure the drug
safety, quality and control of drug prices. Reducing Import dependency country
started to become more self-reliance in drugs, foreign dominance on the
drug sector was lessened and local pharmaceutical industries began establishing
large and modern technology based drug manufacturing facilities.
Bangladesh pharmaceutical sector attained a glorious image in the
international arena, transition of Bangladesh from a drug importing country
to a drug exporting country.
Drugs are regard as specialized consumer products and the patients is
considered as an exceptional customer who need professionals advice during any
ailment from the physicians to procure drugs from a the pharmacy, indicating type
its doses route of administration and duration in a particular diseases
condition and to know the side effects of drugs against the potential
benefits. Medical professionals, pharmacists dispensers nurses and other health
staff should have the capacity to make information decisions about all aspects of
drug use for patients in their respective responsibilities. Therefore they need
special training and access
to necessary medical therapeutic information. The production,
distribution,
10
M. Rahman, ‘High Risk Behavior among drug Abusers in Bangladesh,’ 8th ed., (Dhaka
Eastern Publication, 2015), pp. 23-27.
storage and dispensing of drugs also require special knowledge
understanding skill and expertise.11

3.3 Drug Act in Bangladesh:

(1) This Act may be called the Drugs Act, 1940.
(2) It extends to the whole of Bangladesh
(3) It shall come into force at once: but Chapter III shall take effect onlyfrom such
6date as the Central Government may, by notification in the officialGazette,
appoint in this behalf, and Chapter IV shall take effect in a particularProvince only
from such date as ihc Provincial Government may, by likenotification, 'appoint in
this behalf.

3.4 Import of Drug Act

Government, the Provincial Governments and the Drugs
Technical AdvisoryBoard on any matter tending to secure uniformity
throughout Bangladeshin the
administration of this Act.
The Drugs Consultative Committee shall consist of two representativesof the
Central Government to be nominated by that Government and onerepresentative of
each Provincial Government to be nominated by the ProvincialGovernment
concerned.
The Drugs Consultative Committee shall meet when required to do soby the
Central Government and shall have power to regulate its own procedure.

3.5 Export of Drugs Act

From such date as may be fixed by the Central Government bynotification in the
official Gazette in this behalf, no person shall export any drugfor the export
of which a licence is prescribed, otherwise than under, and in accordance with,
such
licence.

11
Ibid.
 Provided that nothing in this section shall apply to the export, subject to the
prescribed conditions, of small quantities of any drug for the purpose
ofexamination, test or analysis or for personal use.
The Central Government may, alter consultation with the Boardand after previous
publication by notification in the official Gazette, make rulesfor the purpose
of giving effect to the provisions of this Chapter

3.6 Manufacture, Sale and Distribution of Drugs

Provided that the exemptions under sections 132 and 133 of the Code
ofCivil Procedure, 1908 (Act V of 1908), shall be applicable torequisitions for
attendance under this clause;
lock and seal any factory, laboratory, shop, building, storehouse orgodown or
a part thereof where any drug is, or is being.manufactured, stored, sold or
exhibited for sale without thenecessary licence under this Act, or where he
has reason to believethat an offence under this Act has been committed or
may continueto be committed;
forbid for a reasonable period not exceeding three months anyperson in
charge of any premises from removing or disposing ofany drug, article or other
thing likely to be used in evidence ol thecommission of an offence under this Act
or any rules madethereunder;
exercise such other, powers as may be necessary for carrying outthe purposes
of this Act or any rules made thereunder.(2) The provisions of the Code of
Criminal Procedure, 1H98 (Act V of1898), in so far as they are not inconsistent
with the provisions of this Act, shallapply to searches and seizures made
under this Chapter.
Bangladesh became independent in 1971. After independence
thelaws, enacted during British and Pakistan period, remain in force
inBangladesh. So naturally Opium Act, 1857, Opinum Act, 1878, ExciseAct,
1909, Dangerous Drugs Act, 1930 and Opium Smoking Act, 1932are enforced in
Bangladesh. But these are not sufficient to make thecountry free from
addiction. That is why “Intoxicant ControlOrdinance, 1989” a more
effective law, was declared.
Subsequentlyit was passed in the parliament as “The Intoxicant Control
Act,1990.”xvii This Act came into force on 2 January, 1990. The earlierlaws were
suspended.xviii The main provisions of this Act are asfollows

3.7 National Medicine Policy, 2016

In national medicine policy, 2016 it says that,
i. To assure rational use of antibiotics all 100 or more than 100 bed hospitals
at governmentand private level of the country must have their own
‘Antibiotic user guidelines’ which must be regularly updated and followed
during delivery of health care services, later on subsequently
‘Antibiotic user guidelines’ will be formulated and implemented for all
hospitals.
ii. Drugs and Therapeutic Committees will be established in all government
and private hospitals of the country to ensure reasonable use of all types of
medicines including antibiotics.

3.8 Policy and Legislation

The government of Bangladesh recognizes drug abuse as one of the most serious
problems and is firmly committed to supporting international, regional and
bilateral efforts aimed at its prevention and control. The national drug
enforcement policy is embedded in the Drug control Act 1990. The government
took measures to amend the Drug control Act 1990 in line with UN Conventions.
The major features of drug abuse prevention and control in this legislation are:
1. Establishment of the National Drug controlBoard (NNCB) with the task of
drug abuse prevention and control, and to encourage foreign and domestic
participation in drug control activities;
2. Compulsory treatment of drug addiction;
3. Establishment of drug treatment canters;
4. Obligation of organizations and individuals to supply information on drug
abuse;
 5. Restrictions and control on prescription of certain drugs which lead
to addiction if abused;
6. Control of production, distribution, prescription, sale and use of sedative,
hypnotic and tranquillizer drugs;
7. Classification of scheduling of drugs according to control measures
and intensity of harmful effects;
8. Different types of punishment for different drug offences according to the
severity of their nature and quantity of drugs involved;
9. Financial investigation of drug crimes;
10. Freezing and forfeiture of assets of drug traffickers; and
11. Establishment of drug testing laboratory to speed up the trial of drug
cases.12

3.9 Health Rights Protection

In order to protect the health rights of the population the government has a
responsibility to establish a strong national reulatory authrioty to ensure the
manufacture, trade and use of medicine are regulated effectively in order to
be able to proect and promote public health in the country.13

3.10 Concluding Remark

There is no specific law regarding antinbiotic use in Bangaldesh and the laws and
policy we discussed above do not elaborate on antibiotics.And what they
have
said are not enough for ensure the rational use of antibiatics.

12
[www.banglapedia.org/httpdocs/HT/D_0286.HTM,last visited on 14 November 2020].
13
The Daily Star, ( 14 August 2013), p.6
 Chapter 4
LEGAL FRAMEWORK RELATING TO ANTIBIOTIC
RESISTANCE OF VARIOUS COUNTRIES

Many Countries (Japan, USA , Colombia) Particularly in EU

( Denmark, Netherlands and Sweden) have implemented national targets to
reduce antibiotic usage, ban on use and re- labeling of antimicrobials
for livestock’s feed, benchmark for antibiotics at farm level and antibiotic
stewardship14
In Vietnam, CDC, partners like the Ministry of Health, and local experts are
working to establish a national surveillance system, which provides structure
to track antibiotic resistance, guide prevention strategies, and report results at
the local and global level. The system is currently implemented in 16
laboratories across Vietnam and allows the country to detect resistant bacteria
where they start, before they spread. Vietnam has made fighting antibiotic
resistance a national priority15.

4.1 Legal Framework and Laws that Enact by India

Now we will take a look at India and try to find out what they are thinking and
what legal framework they have made. Look, India is our neighbor. We
have many similarities with them, E.g. Education, culture, lifestyle, eating
habits, thinking and much more. India's position on the subject we are researching
is very good, but it is not. India is in a very similar situation to us. But they have
already
realized the importance of the issue and some steps they have already taken.

14
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6563746/, last visited on 01/12/2020]
15
[https://www.cdc.gov/drugresistance/solutions-initiative/stories/ar-global-threat.html,last
visited on 01/12/2020]
 In India, they have a national action plan for antimicrobial resistance. Where it
included, Improve awareness and understanding of AMR through effective
communication, education, and training, Strenghen knowledge and evidence
through surveillance, reduce the incident of infection through effective infection,
prevention and control, optimize the use of antimicrobial agents in all
sectors, promote investment for AMR activities , research and innovation.16
India has few regulations on antibiotic use in food animals. Most existing
laws are concerned with exports and aquaculture. Recommendations have
been made by various bodies to regulate the non-therapeutic use of
antibiotics in animals, including by the National Centre for Disease Control, the
Central Drugs Standard Control Organization and the Directorate General of
Health Services, Ministry of Health & Family WelfareThough, none of these
recommendations have been formalized as regulations or laws.However, they
have taken some effective legal framework
Last year, Union health ministry of India banned the manufacture, sale and
distribution of the antibiotic colisioin and its formation for food producing
animals, poultry, aqua farming animal feed suppliment 17. and they are trying
to take more legal framework like this. There is a laws that regulate antibiotics in
food animals within India. In January 2012, G.S.R. 28(E) required that medicine
for treatment of animals state a withdrawal period 1 in the labeling (Ministry
of Health and Family Welfare, Department of Health 2012). For medicines with no
defined withdrawal period, withdrawal periods in meat/poultry and
marine products should be 28 days and 500 degree-days, respectively.

4.2 Legal Framework Made by EU

In 2006, the EU banned all antibiotic growth promoters. Since the ban of
avilamycin, erythromycin, vancomycin, and virginiamycin as antibiotic
growth

16
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6618210/,last visited on 02/12/2020]
17
[https://www.theweek.in/theweek/cover/2020/01/03/need-more-laws-to-deal-with-
antimicrobial-resistance.html, last visited on 01/12/2020]

14
promoters in Denmark, antibiotic resistance levels in humans have
decreased, suggesting that the agriculture ban has had the desired
effect. For example, following the ban on virginiamycin as a growth promoter in
1998, virginiamycin resistance decreased by one-third by 2000. In Great Britain
the percent of S. typhimurium isolates from calves resistant to tetracycline
dropped from 60 percent to 8 percent in the seven years after banning tetracycline
for growth promotion.
Based on the council regulation established in 1990, (EEC) No. 2377/90, the
commission regulation (EU) 37/2010 outlines maximum levels of antibiotics
in foodstuffs of animal origin. This commission regulation also includesa list
of several antimicrobials that are banned from use in food products because
safe levels have not
been determined. They are chloramphenicol, dapsone, dimetridazole,
metronidazole, nitrofurans (includingfurazolidone), and ronidazole.
In November 2011, the EU put forward a five-year plan to fight against
antimicrobial resistance. The plan included 12 recommendations to
restrict veterinary use of antibiotics, both new antibiotics and antibiotics
that are considered critically important to humans. Other recommendations
focused on the
‘promotion of appropriate use of antimicrobials’ and the strengthening
of
‘regulatory frameworks on veterinary medicines’. In addition, the commission
suggested a new animal health law pertaining to good farming practices to avoid
infections and the reduction of antimicrobials in aquaculture, to be
implemented shortly18.
The World Health Organization Regional Office for Europe also released
a
strategic action plan on antibiotic resistance in 201119.Strategic objectives include

18
[https://www.researchgate.net/publication/45185021_The_European_ban_on_antibiotic_gro
wth_promoters_in_animal_feed_From_challenges_to_opportunities,lastvisitedon
01/12/2020]
19
World Health Organization Regional Office for Europe 2011
the prevention and control of the development and spread of antibiotic resistance in
the veterinary and agricultural sectors20

4.3 Legal Framework Made by United States

The U.S. Food and Drug Aministration (FDA) prohibits the extra-label (off-label)
use of certain antibiotics in food-producing animals. Extra-label use in livestock
includes using the drug at unapproved dosage levels, as a growth promoter or for
disease prevention, and using drugs meant for one species on another (for
example, using cephalosporins meant to treat humans on chickens). The use
of chloramphenicol for any reason is prohibited21
And they have taken The National Action Plan for Combating
Antibiotic- Resistant Bacteria (CARB), 2020-2025, has been updated and
presents coordinated,strategic actions that the United States Government will
take in the next five years to improve the health and wellbeing of all Americans
by changing the course of antibiotic resistance, reported the US Department
of Health and Human Services 22

4.4 Concluding Remark

In foreign countries we have seen that they are aware enough to prevent
the misuse or unwanted use of antibiotics, and in that sense they have taken
various legal framework or legal legal framework .Although we did not see any
punitive law to prevent these abuses.Bangladesh can follow the model of these
countries and impose the necessary sanctions. There is ample room for
doubt as to how
effective these sanctions will be in Bangladesh.Therefore, in addition to enacting

20
Ibid.
21
FDA 2012
22
[https://www.hpnonline.com/infection-prevention/antibiotic-stewardship/
article/21158128/national-action-plan-for-combating-antibioticresistant-bacteria-updated-for-
2020-through
2025#:~:text=The%20National%20Action%20Plan%20for,the%20course%20of%20antibioti
c%20resistance%2C,last visited on 02/12/2020]
these prohibitions and preventive laws, it is also important for Bangladesh to have
punitive laws for violators of prohibitions and preventive laws
 Chapter 5
NECESSARY STEPS CAN BE TAKEN

Bangladesh is a developing country in the 3rd world.Considering the social

context of this country, it is seen that there is a lack of awareness among
the people.Antibiotics have revolutionized human medicine, it's real.But it is
not understood by common people that,looking for antibiotics to solve any
physical problem is not a good idea or they have no scope to aware about
that. Again, financial matters also play a role here.Where people are finding
solutions to antibiotics, they find that it unnecessary to spend money and seek
medical advice, because when they visit the doctor, he prescribes that antibiotic
again.
The first thing to do here is to raise awareness among the people. But till
yet our government has no initiative to make the people aware of this issue.In this
case, the Bangladesh government can form a National Action Plan For Microbial
Resistant, like India. Which will be included these like Improve awareness
and understanding of AMR through effective communication, education and
training. Strengthen knowledge and evidence through surveillance etc.
In the previous chapter 3 we have seen that,in Bangladesh, antimicrobials
are most commonly prescribed group of drugs in general and in hospital. A
majority of the prescriber, specially new doctors prescribe antimicrobial for
increasing their good will.Since then, the sale of antibiotics without a prescription
has become a common occurrence in pharmacies in Bangladesh.92% of
23
antibiotics are sold without a prescription Unchecked use of antibiotics in
poultry, fish and veterinary feeds are common in Bangladesh and their unplanned
use in treating diseases contribute to the increase in antibiotic resistance.

23
Ibid.
 That the antibiotics are being prescribed, sold or used in poultry, fish and
veterinary feeds as their own will,There is no authority in our country to supervise
these.So a strong supervisory authority is needed to properly supervise these
matters.This authority may also be given magistrate powers in law.
Also in order to ensure the proper use of these antibiotics, any kind of use,
sales rules are not yet in the form of law in our country.The issue is so important
that it is time to enact a Separatelaw on antibiotics use, sale and on
prescribe.Because of the way this antibiotic is being used in Bangladesh, the
severity of resistance will reach a critical level in the future.And one day
the situation will get out of control.And if that happens, it is beyond
our comprehension what the impact will be in a populous country like ours.So now
it is the time to consider the real situation, and enact a new law
about antibiotic.Although it should have been done much earlier.The existing drug
law does not elaborate on antibiotics that we found in previous chapter 3.
And I left out the words of the people. They may be using these as they
wish without knowing its consequence. But the doctors who have prescribe
antibiotic as his own wish, they must know about the consequence of over use of
antibiotics.Even then they don’t keep it in mind when writing prescriptions.They
prescribe antibiotics on prescription when even its don’t need to prescribe. So these
doctors have to be brought under a law.What rules they will follow when
prescribing antibiotics, how much to prescribe, under what circumstances the
patient may be given antibiotics, etc.They may even be punished for violating this
rules. It could be revocation of medical license or imprisonment or fine
And the pharmacy owner, they are all known that selling these antibiotics
without prescription is unethical.Even then they sell them without a prescription
for their own profit.Although there are still guidelines in this regard, only a few
large pharmacies follow these instructions.And there is no legal obligation to this
instruction. So they are not paying attention to the instructions .So They also have
to be brought under a obligatory law that what rule they have to follow regarding
sale of these antibiotic and conversely, they could face penalties, including
revocation of their drug licenses.
 Then those who raise poultry, fish, cows commercially, also know
how bad the use of these antibiotics is for the human body.Even after that
they are using it for their own benefit.Traders in these sectors can also be brought
under a binding lawand conversely, they also could face penalties .including
revocation of their trade licenses.
In the future, this antibiotic resistance will be a threat to our very
existence. So realizing the importance of this, a separate antibiotic law should be
enacted now.Where the production, use, purchase, sale and other relatable matter
of antibiotics will be detailed.Therefore, in addition to enacting these prohibitions
and preventive laws, it is also important for Bangladesh to have punitive laws for
violators of this law.
 Chapter 6
CONCLUSION

6.1 Recommendations
The recommendations of this Study are-
i. Government can formedaNational Action Plan For Microbial Resistant,
Which will be included these like Improve awareness and understanding of
AMR through effective communication, education and training among
the people
ii. To assure rational use of antibiotics, a strong supervisory authority is needed
to be formed.This authority may also be given magistrate powers in law.
iii. To assure rational use of antibiotics ,a separate law about antibiotic should be
enacted, where the production, use, purchase, sale and other relatable matter
of antibiotics will be detailed.
iv. At the same time, necessary amendments have to be brought in the
penal code to punish the violators of this law.
v. Doctors have to be brought under a law that what rule they have to follow
while they prescribe antibiotics, how much dose to prescribe and under what
circumstance the patient may be given antibiotics etc.They may even be
punished for violating the rules.It could be revocation of their medical license
or imprisonment or fine
vi. All kind of pharmacies in Bangladesh have to be brought under a obligatory
law that what rules they have to follow regarding sale antibiotics and
violators of these rules can be punished like, revocation of drug license and
imprisonment or fine.
vii. The use of antibiotics in poultry, fisheries and dairy industries should
be stopped by law. The existing situation cannot be controlled with
instructions alone.
viii. To assure rational use of antibiotics all hospitals (governmentand
private) level of the country must have their own ‘Antibiotic user guidelines’
which must be regularly updated and followed during delivery of health
care services.
ix. Drugs and Therapeutic committee should be formed in all public and private
hospitals to ensure rational use of drugs including antibiotics.

6.2 Conculsion
The prevalence of antibiotic abuse is very high in Bangladesh. It is a
thunder signal for us. If such a situation continues, we will be in a very
bad situation within next couple years. And at some point it will become a threat
to our very existence.I have tried to highlight here what kind of legal action we
can take in terms of our reality and the legal framework taken by other
countries in the world.However, this legal step will not be enough.In
addition to these legal measures, the governmenthas to Promote
investments for AMR activities, research, and innovations.
 REFERENES

Book
1. M. Rahman, ‘High Risk Behavior among drug Abusers in Bangladesh,’ 8th ed.,
(Dhaka Eastern Publication, 2015).

Journals
1. Dr. Asfaque, “Antimicrobial Resistance & Infection Control”, Journal
of Antimicrobial Resistance & Infection Control.Vol. No. 6 (2015).
2. FR. Chowdhury Rahman, ‘Rationality of Drug Uses: Its Bangladeshi
Perspectives’ Journal of Mymensingh Medical, Vol. 15 No. 2 (2006).
3. J. Roy ‘Health Status, Treatment and Drug Use in Rural Bangladesh: A Case
Study of a Village’ Australian Journal of Rural Health, Vol.5 No.2, (1997).
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Perspective,” Journal of Current and Advance Medical Research, Vol. no
5 (2018).
6. SM Ahmed Hossain, ‘Knowledge and Practice of Unqualified and Semi-
Qualified Allopathic Providers in Rural Bangladesh: Implications for the HRH
Problem.’ Journal of Health Policy, Vol. No. 84, (2007).

Report
1. World Health Organization Regional Office for Europe 2011
Statutes
1. The Drugs Act, 1940,s.18.
2. Code of Civil Procedure Act, 1908, s.10.
3. Dangerous Drugs Act, 1930, s.1

News Paper
1. The Daily Star, ( 14 August 2013).

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