The Ministry of Health and Population (MoHP) has endorsed the National Antibiotic Treatment Guidelines-2014, which has specified antibiotic treatment protocol of various medical wings, including general medicine, surgery, paediatrics, obstetrics and gynaecology, sexually transmitted infection, ophthalmology, ear, nose and oropharynx and dental.

The guideline has specified the use of each of the listed antibiotics for various diseases in Sub-Health Post, Health Post, Primary Health Care Centre and District Hospital to the zonal and other referral hospitals of the government. For instance, for any Enteric Fever that has symptoms such as fever, body ache, headache, drowsiness, among others, the health posts and hospitals are required to use Ciprofloxacin 500 mg, Cotrimoxazole 160/800 mg and Ofloxacin 400 mg while the referral centres are only allowed to use Chloramphenicol 500 mg and Injection Ceftriaxone 1g including the drugs used by lower level health centres. Also outlined in the guideline are series of all drugs and their treatment regimens.

Antibiotics used in country have become resistant to many diseases, Chief of Curative Division at the MoHP Dr Guna Raj Lohani warned, adding that this could lead to a situation where common diseases will not be cured by the antibiotics in hand unless there is a mechanism to check on the haphazard use of such drugs. “We will implement this guideline in all the government hospitals and slowly enforce it in private clinics and hospitals too,” said Dr Lohani.

The consequences of anti-biotic resistance are severe and several. Infections caused by resistant microbes fail to respond to treatment, resulting in prolonged illness and greater risk of death, the guideline states.

“It leads to higher treatment costs, longer hospital stays, and unnecessary deaths. The more we use antibiotics, the more we contribute to the pool of antibiotic-resistant microbes,” the guideline adds. “Even with appropriate antimicrobial use, resistance emerges and the progress is more rapid when there is inappropriate use.”

It has categorised health institutions in three levels based upon infrastructure and sanctioned post of healthcare providers. It also requires every hospital to develop policy, guidelines and procedures for use of antibiotics.

The World Health Organisation (WHO) in its report titled “Antimicrobial Resistance: Global Report on surveillance 2014”, has warned “without urgent action we are heading for a post-antibiotic era in which common infections and minor injuries can once again kill.”

Experts point out patients not following the prescribed course of medications as one of the reasons for the bacteria developing resistance against such drugs. Contrary to the Drug Act 1978 that allows the sales of antibiotics only under doctor’s prescription, the drugs are freely prescribed by many health professionals in the country, regardless of diagnosis.

A study conducted by the Institute of Medicine in 2013 had revealed an alarming rise in resistance to drugs by the bacteria that cause typhoid and urinary tract infections. Drugs such as Ciprofloxacin—which was widely used to treat typhoid—have become ineffective, thanks to a rampant prescription of the drug.