Prevent Misuse of Antibiotics in Nepal

Antibiotics consumption is quite high in health care settings of Nepal [1, 2]. Antimicrobial resistance (AMR) is a growing problem resulting in heavy loss and economic burden [1, 2]. Though no comprehensive nationwide study exists, various studies have shown that resistant microbes are rampant in animal and human health sector [1-3]. This crisis of AMR is closely linked to the availability of antibiotics over the counter without prescription, irrational use, failure to follow prescribed course of antibiotics, lack of effective surveillance system and antimicrobial stewardship in animal and human health sector [2, 4], and widespread overuse of antibiotics as growth promoter in animal feed [1, 5]. In addition, culture and antibiotics sensitivity facilities are not available in many health care settings [6, 7], as a result, antibiotics are mostly prescribed syndromically [8]. Furthermore, poor infection control system and poor sanitation and hygiene have further added to the problem of AMR in Nepal [1, 9].

Laws exist regarding the prudent use of antibiotics [10, 11] and infection control systems in Nepal [11], but the problem lies with implementation, as for example, antibiotic treatment guidelines-2014 issued by curative division of Ministry of Health and Population (MoHP), but has hardly been followed [6]. The poor implementation and non-compliance to standard guidelines have facilitated increased emergence and transmission of drug resistant microbes [2, 6]. The above mentioned conditions warn that Nepal is not prepared enough to detect, prevent and respond to the threat of AMR. However, it is not too late. The Government of Nepal (GoN) should prioritize AMR and adopt rigorous AMR action plan that includes: 1) Development of laboratory networks to quickly detect, report and respond. 2) Development and imple-mentation of rigorous surveillance system 3) Development of qualified manpower to do surveillance, test sample and perform data analysis 4) Creating an enabling environment to engage physicians, veterinarians and other community members to promote the prudent use of antibiotics, personal hygiene, sanitation, and vaccination.

Controlling AMR is difficult but feasible, which needs a high level of political, social and economic commitment.

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