On Monday morning, a number of people who had prescriptions were waiting their turn to buy medicines at AM Pharma in the PC Culture Housing area of Mohammadpur in Dhaka.
A customer appeared without a prescription and asked the shopkeeper for two Ciprocin tablets. The shopkeeper sold the two tablets of the antibiotic to him for Tk30 without hesitation.
Earlier on Sunday night, a Business Standard correspondent in a similar fashion bought three Zmax antibiotic tablets from Abir Pharmacy in the city's Kalabagan area.
Buying medicine like this without prescription is not an exception here – it is a common practice in the city and beyond.
The High Court on April 25 this year ordered the government to take measures to stop the sale of antibiotic drugs without prescriptions from registered doctors.
The HC bench of Justice Sheikh Hassan Arif and Justice Razik-Al-Jalil passed the order based on a writ petition filed by Barrister Sayedul Haque Suman of the Supreme Court.
The correspondent went to several drug stores in different areas of Dhaka, including Farmgate, Green Road, Kalabagan, Mohakhali and Mohammadpur, to check if drugstores are following the High Court order.
She did not face any problem buying antibiotic medicines from most of the drug stores she went to. Only drugstores like Lazz Pharma, Tamanna Pharmacy and some other pharmacies refused to sell antibiotic medicine to this correspondent without a doctor's prescription. She even bought antibotics from a drugstore near the office of the Directorate of Health Services.
When asked, the drug sellers said they are aware of the government's restrictions on selling antibiotic drugs. The seller at Abir Pharmacy in Kalabagan said there are many laws in the country, but people do not care a fig about them.
However, physicians said that the uncontrolled sale of antibiotics by drugstores and quacks without registered doctors' recommendations is leading to their misuse.
Dr AKM Habib Ullah, a consultant of Anaesthesia, Analgesia and Intensive Care Medicine at the Bangabandhu Sheikh Mujib Medical University (BSMMU), said drug sellers and quacks are prescribing antibiotics without a proper knowledge on which diseases need which antibiotics.
Moreover, patients do not complete the full course of antibiotics prescribed by registered physicians; as a result, the bacteria inside a patient's body develop a strong resistance to the antibiotics, said Dr Habib Ullah.
If it continues like this, there will be a bad situation in the next five to 10 years, he warned.
Antibiotic resistance is when bacteria develop the ability to survive exposure to antibiotics designed to kill them or stop their growth.
Physicians say that the unnecessary or inappropriate use of antibiotics is increasing the risk of bacterial resistance.
Cases of antibiotic resistance are seen the most in intensive care units (ICUs). Physicians say 25 percent of patients admitted to ICUs are antibiotic resistant.
Professor Md Sayedur Rahman of the pharmacology department at BSMMU has been working on antibiotic resistance for a long time.
He told The Business Standard that there is no information on how many people die in the country each year as a result of antibiotic-resistant infections.
According to an article titled "Antimicrobial resistance: Reality, danger and things to do", authored by Professor Sayedur Rahman, there are 2,30,000 drugstores in the country.
Two lakh people who are illiterate, half-literate and untrained are working in these stores and providing treatment.
They sell around 10 lakh antibiotic drugs every day without any prescription, which comes to around 36.5 crore antibiotic drugs per year, said the article.
The high sales show that the use of antibiotics is increasing across the country.
According to the health data of the Institute Management System, Cephalosporin was the second highest (Tk1,688 crore) sold antibiotic drug in the country in 2018.
Professor Sayedur said selling medicine without prescription has to be stopped to prevent the misuse of antibiotics, and called for a red colouring on packets of antibiotics.
He also said that each packet of an antibiotic should contain a full course. The word 'antibiotic' should also be inscribing in Bangla on the packet, and a lesson on antibiotic resistance should be included in textbooks.
Ruhul Amin, director of the Directorate General of Drug Administration, said they have been trying to stop the sale of antibiotics without doctors' prescriptions.
He told The Business Standard that they have already put up posters in different drugstores asking them to stop selling antibiotics without prescription.
Moreover, drug administration officials are monitoring and counselling sellers at the drugstore to stop this practice, he said.
He claimed that the situation is changing gradually, and that many drugstores and pharmacies are not selling antibiotics without a doctors' prescription.