Every week in winter, Dr Anup Subedee, an infectious disease consultant at the Kirtipur Hospital, lost up to five patients, who included children, women and elderly people. Cases of burn injuries generally rise during winter and antibiotic resistance is the chief culprit for the high mortality among burnt patients.

“Antimicrobial resistance has reached alarming levels in our country,” said Subedee. “Even antibiotics available in the country do not work in some cases and have to be ordered from India.”

Antimicrobial resistance is a serious public health issue leading to a ‘silent pandemic’ in the country, according to public health experts in Nepal.

A preliminary report of a study entitled ‘Community Education and Surveillance of Antibiotics Use among Young Children: Experimental Evidence from Nepal’ said antibiotics without prescription were administered in 65 percent of cases.

The study, carried out in collaboration with the Pennsylvania State University, GTA Foundation, Henry Ford Health, and SunyaEk in Kathmandu, Lalitpur and 11 adjacent municipalities, shows that educational intervention was successful in reducing the use of antibiotics without prescription.

Children in the intervention group were about 15 percent points less likely to be given antibiotics without a prescription, according to the report.

Trained nurses were sent to households to share knowledge about the irrational use of antibiotics.

"Nurses talked about the risk of consuming antibiotics without doctors’ prescription, not following the right doses,” the report stated. “They shared information using a video specially designed for this purpose.”

The World Health Organisation said antimicrobial resistance happens when bacteria, viruses, fungi and parasites change over time and no longer respond to medicines, making infections harder to treat and increasing the risk of disease spread, severe illness and death. As a result, the medicines become ineffective and infections persist in the body, increasing the risk of their spread to others.

Antibiotics, despite being prescription drugs, can be easily purchased over the counter in Nepal. Many people buy them without telling the pharmacists their exact problem. Pharmacists too do not bother to inquire and in most cases fail to emphasise the importance of completing the course of medicine, which is among the main reasons for the growing rate of antimicrobial resistance, according to experts.

Second, most of the time doctors prescribe antibiotics on the basis of clinical diagnosis, even before they get laboratory test reports. Experts say antibiotics do not work if the underlying infection is caused by a virus.

According to a 2021 study of the Nepal Health Research Council (NHRC), only 32 percent of the doctors and health workers have access to laboratories for antibiotic susceptibility testing. Among them, only 49 percent of doctors recommend antibiotic susceptibility testing before prescribing antibiotics. This means that only 16 percent of doctors recommend antibiotics after susceptibility testing.

The study also shows that more than one-third—37.8 percent—of prescribed medicines were antibiotics, which is higher than the World Health Organisation’s standards.

The study shows about one-fourth (22 percent) of the outpatients did not consume a full course of antibiotics. Similarly, about 10 percent of the outpatients consume antibiotics as prophylaxis (preventive treatment) while eight percent take double-dose antibiotics for a quick recovery.

Around 22 percent of them save residual antibiotics for the treatment of similar symptoms in the future. Additionally, around 28 percent of outpatients said they buy antibiotics without doctors’ or health workers’ prescriptions.

The report shows that a significant number of patients do not know that a course of antibiotics must be completed and if they stop halfway, the same antibiotic may not work the next time.

While human antibiotic use contributes to antibiotic resistance, the widespread use of antibiotics in agricultural applications—most notably livestock and poultry production—is also a potential driver.

Doctors say agricultural antibiotics contribute to the presence of resistant bacteria in meat and poultry products; in addition, resistant organisms are released from farms into soil, groundwater, and surface waterways, leading to contamination of water sources used for crop irrigation and domestic purposes.

The NHRC study showed around 70 percent of farmers used progressively higher doses of antibiotics and more frequently for faster recovery of sick animals or fowls.

The study identified big shortcomings in awareness and availability of national guidelines for prescribing antibiotics and infrastructures for recommending antibiotic susceptibility tests among both human and animal health professionals.