The Department of Drug Administration has banned the sale of six reserved antibiotics in pharmacies, except those run by hospitals.

The move of the national drug regulatory body aims to prevent the irrational use of antibiotics in dispensaries mushrooming across the country.

“The reserved antibiotics, prohibited from being sold in pharmacies except those operated by hospitals, are meant to be used as a last resort or in the intensive care and for seriously ill patients admitted to hospitals,” said Pramod KC, spokesperson at the department. “But pharmacies have been found selling these medicines to patients without a doctor’s prescription, and even in the initial stages of illness.”

The irrational use of antimicrobials in humans, animals and plants is leading to a ‘silent pandemic’ in Nepal, according to public health experts. Antibiotics, which have saved millions of lives, could soon become ineffective due to the high resistance rate caused by their irrational use, they warned.

The DDA-restricted antibiotics include Meropenem, Polymyxin B, Piperacillin+ Tazobactam, Vancomycin, Colistin and Linezolod.

KC said that these reserve group's antibiotics are fourth-generation and fifth-generation antibiotics, which are used only when all alternative antibiotics fail.

“To combat rising antimicrobial resistance, improve clinical outcomes and preserve the effectiveness of antibiotics, we have decided to ban their sale in all pharmacies,” said KC. “These antibiotics are also on the national list of essential medicines and the ban is in line with the decision of the World Health Organisation’s global Antimicrobial Resistance Action Plan.”

The World Health Organisation states that 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 spreading to others.

Although antibiotics are prescription drugs, they can be easily purchased over the counter. Many people buy these drugs without fully explaining their exact symptoms, and pharmacists often do not bother to inquire and, in most cases, fail to emphasise the importance of completing the full course.

Doctors, too, often prescribe antibiotics on the basis of clinical diagnosis, even before they get laboratory test reports. Experts say antibiotics do not work against viral infections.

Doctors in Nepal said that antimicrobial resistance is a common problem, particularly among patients requiring intensive care. What alarms doctors and experts is that the problem is not limited to critically ill patients, but it also affects those seeking outpatient treatment.

They say that misuse, random use, and irrational use of antimicrobials, which can be purchased over-the-counter, have been leading to a severe crisis in our country. Most patients arrive at the hospital after using high-grade antibiotics.

Experts stress that antibiotic sensitivity testing should be conducted before prescribing these drugs, but very few doctors take the time to assess a patient’s response to the medication. Patients, too, are often unaware that the course of antibiotics must be completed and if they stop halfway, the same antibiotic may not work the next time.

“Uncontrolled use and misuse of antibiotics lead to resistance, meaning that the same drugs may not work again,” said Dr Sameer Dixit, a public health expert. “Authorities must enforce strict controls on antibiotic misuse and over-the-counter sales.”

Doctors warn that antibiotics, which are one of the most potent tools for treating bacterial infections, are becoming increasingly ineffective. They say that when higher doses of antibiotics and fourth- and fifth-generation antibiotics are given to patients without knowing the exact cause of ailments, the risk of antibiotic resistance increases.

A study carried out in the past in Nepal on humans, animals, and environment samples detected antimicrobial resistance genes in 81 percent of tested samples.

Antimicrobial resistance has emerged as a worldwide concern due to the acute health threat posed by antibiotic-resistant pathogens. While human antibiotic use contributes to antibiotic resistance, the widespread use of antibiotics in agricultural applications, most notably in livestock and poultry production, is another potential driver.

Doctors say agricultural antibiotic use leads to the presence of resistant bacteria in meat and poultry products. Additionally, resistant organisms from farms enter soil, groundwater, and surface waterways, and contaminate water sources used for crop irrigation and domestic consumption.

Meanwhile, the national drug regulator has also prohibited the production, sale, and import of Atorvastatin 5 mg tablets and Empagliflozin 5mg tablets—used for cholesterol and diabetes—stating that these doses are ineffective for patients.