Antimicrobial resistance is a common problem for most patients requiring intensive care in hospitals. What alarms doctors and experts is that the problem is not limited to patients with serious ailments but it also affects those seeking outpatient care.

The irrational use of antimicrobials in humans, animals, and plants has led to a ‘silent pandemic’, and many people, including policymakers, have not taken the issue seriously.

“Misuse, random use, and irrational use of antimicrobials, which can be purchased over-the-counter, has been leading to a serious crisis in our country,” said Dr Raju Pangeni, a pulmonary and critical care physician at Hams Hospital. “Most patients arrive at the hospital after using higher-grade antibiotics.”

Experts warn that antimicrobials, which have saved millions of lives throughout the world, could soon become ineffective due to the high resistance rate caused by their irrational use.

The World Health Organisation said antimicrobial resistance occurs when bacteria, viruses, fungi and parasites evolve 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, 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 explaining their exact problems to pharmacists. And in many cases, pharmacists do not bother to inquire and fail to emphasise the importance of completing the prescribed course of medicine, which is among the main reasons for the growing rate of antimicrobial resistance, according to experts.

Moreover, doctors usually prescribe antibiotics based on clinical diagnoses, even before receiving laboratory test reports. Experts say antibiotics do not work if the underlying infection is caused by a virus.

According to experts, a patient’s sensitivity to antibiotics must be known before prescribing them, but very few doctors take the time to understand their patients' sensitivity to the drugs they prescribe. Patients are also unaware that the course of antibiotics must be completed and stopping them halfway could render the same antibiotic ineffective in the future.

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 recommend antibiotic susceptibility testing before prescribing antibiotics. This means that only 16 percent of doctors recommend antibiotics after conducting susceptibility testing.

“There is a significant reason influencing rational prescriptions of antibiotics,” the report stated.

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 outpatients consume antibiotics as prophylaxis while eight percent take double-dose antibiotics for a quick recovery.

Around 22 percent of them save leftover 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.

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. Also, 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 major shortcomings in the awareness and availability of national guidelines for prescribing antibiotics and infrastructures for recommending antibiotic susceptibility tests among human and animal health professionals.

In a study of human, animal, and environmental samples carried out in the past, antimicrobial resistance genes were detected in 81 percent of the total samples on which antimicrobial resistance tests were carried out.