In his first 12 years working as a vet in Bangladesh, Bikash Chandra Saha routinely prescribed antibiotics. Then he learned of the devastating impact of antimicrobial resistance on human health — and it revolutionized his treatment choices.
The growing resistance of deadly diseases to antimicrobial drugs such as antibiotics is seen as one of the biggest threats to human health, but awareness of the dangers of overuse remains low, particularly in developing countries.
Now the United Nations is educating workers on the front lines of the battle against this global scourge — among them Saha, who works for one of Bangladesh's biggest poultry companies.
"It definitely changed my attitude and my antibiotic selection," Saha, who attended a recent training course, told Reuters by phone.
"Before, my focus was on what is the best option [for the animal]. After the training, I know the threat of antimicrobial resistance, even for my family, for my children. This is a new thing."
Lethal bacteria are showing more and more resistance to antimicrobials, and a 2016 report found drug-resistant infections could kill 10 million people a year by 2050.
Livestock is a large part of the problem — especially in Asia, where rising incomes have led to a growth in the consumption of fish and meat.
Most countries require prescriptions for antibiotics in humans, but less than half limit their use to promote growth in agriculture, according to a report published last month.
Saha said colistin, once a livestock-specific antibiotic but now a drug of last resort that can save human lives when others have failed, was commonly used on animals in Bangladesh but since the training he and the other vets were more careful about using it.
The course was run by the U.N. Food and Agriculture Organization (FAO), which has trained nearly 150 vets and doctors in Bangladesh since February on the globally accepted guidelines for antibiotic use.
Those guidelines are now available as mobile phone app — one of a number of innovative ways in which international organizations are seeking to educate people working with antimicrobial drugs about the dangers of overuse.
Thailand, where antimicrobial resistance causes 19,000 additional deaths a year, is working on an online dictionary in English, Thai, Vietnamese, Lao and Burmese to cut through the jargon surrounding the issue.
"In the Mekong region, people don't clearly understand the difference between bacteria and virus," said Direk Limmathurotsakul, assistant professor at Bangkok's Mahidol University, who is leading the project.
"People still commonly use antibiotics for common cold, which is caused by virus," he added. "Even the word antibiotic can be called different ways. In Thailand, sometimes it is called anti-inflammatory or antiseptic drug."
Simply banning antibiotics would not work, experts say, with farmers unlikely to comply.
Instead, they hope improved knowledge of drugs will help reduce antimicrobial use on Asian farms — seen as the low-hanging fruit because it is currently so high.
In Vietnam, 120 poultry farmers are to receive training on how to prevent and control diseases as well as free veterinary advice as part of a pilot project aimed at reducing drug use.
"We're improving the knowledge base of farmers and vets rather than a ban on antibiotics, which would be unlikely to be complied with," said Juan Carrique-Mas, the project's principal investigator.
"The baseline shows very high level of usage, so I think it would be relatively easy to reduce it by 30 to 50 percent with even better productivity and health," added Carrique-Mas, of the Oxford University Clinical Research Unit in Ho Chi Minh City.
Data on antibiotic use on farms in the region remains sparse, but is starting to be collected, said Suzanne Eckford, a British specialist who works with the FAO.
Eckford advocated against blanket bans on antibiotics — not least because they could have unintended consequences on food production.
"You can't just say, 'don't do something,'" she said. "You have to say, 'this is what you need to do instead and you'll be still able to have a productive, economically viable system.'"