Understanding the social drivers of antibiotic use during COVID-19 in Bangladesh: Implications for reduction of antimicrobial resistance

PLoS One. 2021 Dec 14;16(12):e0261368. doi: 10.1371/journal.pone.0261368. eCollection 2021.

Abstract

Antimicrobial resistance (AMR) is a global public health crisis that is now impacted by the COVID-19 pandemic. Little is known how COVID-19 risks influence people to consume antibiotics, particularly in contexts like Bangladesh where these pharmaceuticals can be purchased without a prescription. This paper identifies the social drivers of antibiotics use among home-based patients who have tested positive with SARS-CoV-2 or have COVID-19-like symptoms. Using qualitative telephone interviews, the research was conducted in two Bangladesh cities with 40 participants who reported that they had tested positive for coronavirus (n = 20) or had COVID-19-like symptoms (n = 20). Our analysis identified five themes in antibiotic use narratives: antibiotics as 'big' medicine; managing anxiety; dealing with social repercussions of COVID-19 infection; lack of access to COVID-19 testing and healthcare services; and informal sources of treatment advice. Antibiotics were seen to solve physical and social aspects of COVID-19 infection, with urgent ramifications for AMR in Bangladesh and more general implications for global efforts to mitigate AMR.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anti-Bacterial Agents / therapeutic use*
  • Antimicrobial Stewardship / methods*
  • Bangladesh
  • COVID-19 / epidemiology*
  • Drug Resistance, Bacterial*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Pandemics
  • Qualitative Research
  • Social Factors

Substances

  • Anti-Bacterial Agents

Grants and funding

This work is partially funded by Bangladesh Bureau of Educational Information and Statistics (BANBEIS), ID number SD2019967. Mohammad Mahmudul Hassan was supported by BANBEIS. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.