Developing resistance

In Europe, 400,000 people a year have antibiotic-resistant infections and 25,000 die as a result. Closer to home, the Indian government is trying to address the factors creating this health crisis. It is encouraging pharmaceutical companies to invest in new antibiotics through research and development, rather than simply seeking more profitable drugs.

In April, WHO released its first report on the global state of antibiotic-resistant bacteria. The report warned that the world is entering a “post-antibiotic era” where even the most powerful antibiotics, like gatifloxacin, ofloxacin, and ceftriaxone, are becoming ineffective because of their overuse, haphazard use, or unnecessary prescriptions by doctors and retail shops. Another rising risk that the unmanaged use of antibiotics poses is a threat to otherwise harmless or beneficial bacteria that reside in our body, leading to ‘superinfection’. But in many parts of the world, including Nepal, many patients continue to die due to a lack of access to such life-saving drugs. Thus, a balance needs to be maintained between access to and rational use of antibiotics.

Antibiotics are the ‘miracle drugs’ of the 20th century. When Alexander Fleming discovered penicillin, the first antibiotic, he already suggested that penicillin only be used when necessary in case bacteria develop a resistance to such drugs. But as in many countries, there is no surveillance system to track antibiotic resistance in Nepal, even as numerous reports have shown that the irrational prescription of antibiotics is leading to a rise in the development of resistant bacteria.

However, there are a number of local interventions that can be made to contain antibiotic resistance. These include reducing the need for antibiotics by improving public health; reducing the burden of infections; combating inappropriate antibiotic use; control of over-prescribing and under-prescribing; reducing antibiotic use for growth promotion in animals; reducing antibiotic  use in agriculture; and ensuring political commitment to oversee the rational use of antibiotic drugs.

Measures to take

The government has included such interventions in its efforts to address antibiotic resistance in Nepal. The national immunisation programme in Nepal has achieved coverage rates of over 80 percent for most diseases. The central veterinary laboratory conducts epidemic investigations and some disease surveillance but no veterinary surveillance network exists. The Ministry of Health has also come up with guidelines and protocols for various hospitals for the appropriate use of antibiotics. The implementation of these guidelines and protocols are monitored by the Department of Drug Administration. There is also a drug and therapeutic committee that is responsible for the rational use of antibiotics in different hospitals. An infection prevention and control committee can also help in the appropriate use of antibiotic in different hospitals. Lacking sufficient governmental interventions, the Global Antibiotic Resistance Partnership-Nepal is working on promoting awareness of antibiotic resistance in the country.

Still, national infection control guidelines have not been established in Nepal and the government’s policies and regulation remain outdated. The Drug Act 1978, National Drug Policy 1995, and Antibiotic Treatment Guidelines 2014 must all be periodically updated along with changing contexts. Last but not least, controlling antibiotic resistance should start with the controlled use of antibiotics in the human and veterinary sector.

If urgent steps are not taken in time, antibiotic resistance can turn into a pandemic, which could devastate a country like Nepal, which already has weak health infrastructure. Of course, there is already a higher rate of bacterial infections in developing countries than in developed countries. The US Centers for Disease Control and Prevention estimated that two million people were infected with antibiotic resistant bacteria last year. If this was the case in a country with a robust health system like the US, we can only imagine what might happen in Nepal.

Thapa is a senior pharmacist at Patan Hospital and president of the Hospital Pharmacist Association of Nepal