Driving Drug Resistance: A Pharmacotherapeutic Analysis of Self-Medication Practices in Bangladesh

Drug resistance has arisen as a major public health challenge to global health, burdening low- and middle-income countries (LMICs), including Bangladesh, disproportionately because of fragile regulatory structures dynamics and limited access to quality healthcare. Haphazard practice of antibiotic self-medication (use of antibiotics without the prescriptions from qualified physicians) has been one of the leading causes of antimicrobial resistance (AMR) here. This article is a narrative review with the objective of rigorously assessing prevalence, pharmacotherapeutic behaviors, risk factors and clinical consequences of antibiotic self-medication in Bangladesh. Longitudinal study using a systematic literature review from PubMed, Google Scholar, ResearchGate, Bangladesh Journals Online, etc has been created by emphasizing on studies of recent years. Commonly misused classes of antibiotics are broad-spectrum agents (e.g., fluoroquinolones, macrolides, 3rd-generation cephalosporins) that are prescribed for inappropriate syndromes, incorrect durations of therapy and at sub-therapeutic doses. Community pharmacies, most of which work under minimal regulations, are the major suppliers of over-the-counter (OTC) antibiotics. Socioeconomic limitations, substantial out-of-pocket healthcare costs, poor access to licensed practitioners, reliance on personal cultural practices for self-treatment of infections with lack of knowledge about AMR risks and prior experience with antibiotics were key determinant identified. Moreover, poor enforcement of drug policies and the informal role pharmacy personnel play in clinical decision-making also contribute to inappropriate antibiotic use. The impact of these practices is substantial, resulting in elevated rates of multidrug-resistant (MDR) pathogens, treatment failure, prolonged illness, and increased healthcare costs. Antibiotic pharmacotherapeutic misuse harms individual patient outcomes and not only hinders the necessary future development of antibiotics but also sustains the growing threat to public health in AMR. A coordinated multilevel response is mandatory for addressing this issue; the need to strictly enforce prescription-only dispensing of antibiotics; strengthen pharmaceutical regulatory systems; program, and train pharmacists to be frontline antimicrobial stewards, and also organize large public awareness campaigns. Ensuring availability and affordability of quality healthcare facility is an equally vital component to discourage people from self-medication. The consequences are severe, though without urgent and sustained interventions, antibiotic resistance will continue to spiral out of control in Bangladesh with significant risks for national and global health security. Successfully addressing drug resistance reduces the disease burden while simultaneously accelerating progress across a range of Sustainable Development Goals (SDGs).