Paper short abstract:

The 'irrational' use of antibiotics is a significant cause of AMR in developing countries including Bangladesh. A qualitative account using the theory of 'Social Lives of Medicines' revealed medical-representatives influence the prescribing and dispensing antibiotics through innovative marketing.

Paper long abstract:

Antimicrobial resistance (AMR), has been acknowledged by the WHO as a serious global public health threat. The 'irrational' use of antibiotics is an important cause of AMR. Like many other developing countries, there is little regulation of drug production, prescription and use in Bangladesh. Unqualified health providers in the informal sector supplement the shortage of qualified health workforce, especially among the poor and in disadvantaged areas. As part of a larger project investigating the pathways of antibiotic use in Bangladesh, this paper explores the role of a specific actor, namely Medical Representatives (MR), for popularizing antibiotics in particular. Key-informant interviews and observations have been conducted with MR and key personnel of various multi-national and national pharmaceutical companies. Our findings revealed, MR influence the prescribing and dispensing pattern of both qualified doctors and non-qualified dispensers through their robust marketing, innovative incentives catering for different health providers, and the symbolic value of their appearance. The theory of 'Social Lives of Medicines' denotes that medicines have lives and that the meaning and use of medicines varies according to the context. The study shows MR of various pharmaceutical companies play a crucial role in interpreting the meaning and use of antibiotics in Bangladesh. This ultimately contributes to the irrational prescribing/dispensing of drugs, which is, in turn, a key contributor to the emergence of AMR. Using Michael Cronin's theory of 'Globalization and translation', we argue, MRs are one of the critical 'translators' of antibiotics that play a major role in antibiotic resistance in Bangladesh.