Antimicrobial Resistance (AMR) is no longer a distant threat; it is an unfolding national catastrophe already claiming lives inside our hospitals. Newly released data from the Institute of Epidemiology, Disease Control and Research (IEDCR) exposes the extent of this crisis with chilling clarity. Four in every ten patients admitted to intensive care units (ICUs) are no longer responding to available antibiotics. This single statistic signals a full-scale collapse of our ability to treat infections that should be curable. Many patients who survive traumatic injuries, major surgeries, or life-threatening conditions are dying from infections that antibiotics can no longer control. What was once the cornerstone of modern medicine is crumbling before our eyes.
The situation becomes even more alarming when examining resistance trends to critical antibiotics. Meropenem—one of the most powerful drugs reserved for severe infections—has seen resistance rates jump from 46.7 percent in 2022 to an astonishing 71 percent in 2025. Several other essential antibiotics now face resistance levels between 79 and 97 percent. These medicines represent our last line of defence, and they are rapidly losing their potency. Compounding this crisis is the surge in the use of WHO-classified "watch-group" antibiotics, which should be used sparingly. Their usage has escalated to 91 percent this year, up from 77 percent the year before. This heavy dependence is accelerating resistance even further, leaving us with dwindling options and fragile reserves of once-reliable drugs.
Although the ICU data is the most dramatic, AMR's impact spreads far beyond hospital walls. Globally, drug-resistant infections directly caused 1.27 million deaths in 2019 and were linked to nearly five million deaths. The trajectory is even more frightening: by 2050, AMR could kill 10 million people annually—surpassing cancer and overwhelming global health systems. The economic toll is equally devastating. The World Bank warns that AMR could strip $ 1 trillion to $ 3.4 trillion from the global GDP every year by 2030, driven by longer hospital stays, rising treatment costs, reduced labour productivity, and disruptions in agriculture and food production. Without urgent intervention, AMR could erase decades of medical and economic progress.
This crisis is pushing us dangerously close to a pre-antibiotic era, when infections were the leading cause of death and routine medical procedures carried enormous risks. Organ transplants, cancer chemotherapy, intensive care, and even simple Caesarean sections depend on effective antibiotics to manage secondary infections. If these drugs fail, many of today's life-saving procedures will become too dangerous to perform. The medical system we rely upon—built on the confidence that antibiotics can control infections—is being dismantled one resistant organism at a time.
The tragedy is that AMR is overwhelmingly man-made. Its drivers are fully within our ability to control, yet remain neglected across the entire health ecosystem. At the community level, self-medication continues unabated. People routinely purchase antibiotics without prescriptions, take incorrect doses, or stop midway when symptoms subside. Each incomplete course allows the strongest bacteria to survive and multiply, ensuring that the same drug will not work again. The ease with which antibiotics can be bought over the counter creates the perfect breeding ground for resistance.
The medical system itself is not blameless. Even trained doctors sometimes prescribe antibiotics without proper diagnostic justification, while unregistered healthcare providers prescribe indiscriminately. The IEDCR has repeatedly emphasised the need for culture and sensitivity tests before prescribing antibiotics, but this essential step is still not universally practised. The culture of "prescribing first and investigating later" is fuelling resistance at a terrifying pace. Inside hospitals, poor infection prevention and control practices allow drug-resistant microbes to spread, turning healthcare facilities into hotspots for resistant infections.
The crisis expands further when viewed through a "One Health lens"—looking at health problems through an integrated approach recognising the connection among human, animal and environmental health. Antibiotics are widely misused in agriculture and livestock production to promote growth and prevent disease, resulting in resistant bacteria entering the food chain and environment. Pharmaceutical waste, often released untreated into water bodies, further contaminates ecosystems with antibiotic residues and resistant organisms. These environmental reservoirs continually feed resistance back into human populations, creating a vicious, unending cycle. Meanwhile, the pharmaceutical industry faces little incentive to develop new antibiotics. These drugs are costly to produce but generate low profits compared to long-term treatments for chronic diseases. As a result, the pipeline for new antibiotics has slowed to a trickle just when we desperately need innovative solutions.
Addressing AMR demands urgent, aggressive, and coordinated action across all sectors. Regulation must be strengthened immediately to end unauthorised antibiotic sales and ensure prescriptions are based on proper diagnostic practices. Hospitals must implement strong, well-monitored antibiotic stewardship programmes (strategies for prescribing and administering antimicrobials) and enforce infection control strictly, treating stewardship as a core institutional priority rather than an optional guideline. Governments and global health organisations must intervene to address the market failure in antibiotic research by incentivising investment in new drugs, rapid diagnostic tools, and vaccines that reduce reliance on antibiotics.
From a One Health perspective, antibiotic use in agriculture must be tightly regulated. Alternatives to antibiotics for growth promotion should be mandated, and strict oversight is necessary to prevent environmental contamination from pharmaceutical manufacturing. Without addressing the animal and environmental dimensions of AMR, human health interventions alone will fail. Equally important is public education. A sustained national awareness campaign is essential to communicate clear, consistent messages: antibiotics do not cure viral infections; self-medication is dangerous; and completing the full course of prescribed antibiotics is mandatory. Changing public behaviour is critical because misuse at the community level is one of the primary drivers of resistance.
The rise of AMR is not an unavoidable twist in microbial evolution; it is a direct consequence of human negligence, weak regulation, medical shortcuts, and system-wide complacency. The warning signs are everywhere, and the data is undeniable. Four in ten critical patients in our ICUs are already losing the fight against infections that should be treatable. If we continue on this trajectory, we will enter a post-antibiotic world where minor injuries become life-threatening and modern medicine becomes a gamble.
Antibiotics are not infinite commodities; they are fragile, irreplaceable resources. We must protect them with the seriousness they deserve. The window for decisive action is closing rapidly, and the cost of inaction will be measured in lives lost, economic devastation, and the collapse of medical systems we once believed were unshakable.
Dr Syed Abdul Hamidis professor of health economics at Dhaka University, convener of Wellbeing-First Initiative Bangladesh (WFIB), and chief adviser of Universal Research Care Ltd.
Views expressed in this article are the author's own.
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