Nepal
 Nepal
has organized a core group of Nepali medical and scientific professionals
committed to APUA's mission and to cooperating and sustaining related
projects. The group consists of representatives of key interest
groups such as DDA, Tribhuvan University.
In the summer of
1997, APUA piloted a surveillance project
which has identified major technical barriers and developed a
model for surveillance of antibiotic resistance in remote areas.
The pilot identified important considerations that need to be
part of a viable surveillance structure in Nepal and other
developing countries. A surveillance software package that is
being developed will facilitate the surveillance there.
APUA has established
arrangements for a lease of space for an
office and laboratory in Khatmandu, and has arranged for a part
time coordinator to lay the groundwork for a culturally sensitive
program which will identify and involve in-country resources
for antibiotic resistance surveillance. The chapter has a
proposal for an antibiotic resistance surveillance and
intervention program and is planning a workshop for emergency
room doctors in the hospitals.
The Nepal government
spends 42% of the national health budget
on drugs, and international donors spend nearly three times as
much. Drug distribution and use in Nepal is largely unregulated
and the pharmaceutical industry is a major and growing market.
80% of the drugs are purchased outside of the
government-supplied health system, mostly through private
retail shops and pharmacies. Nine thousand druggist shops in 75
districts supply 80% of the drugs. Even when antibiotics are
prescribed, they are not used correctly. 72% of all drug
prescriptions are in non-compliance with standard norms, and
38% of patients misunderstood dosage and administration
requirements. Ciprofloxacin is becoming the treatment of
choice for physicians, drug sellers and the public.
Although valid research
on antibiotic resistance in Nepal is
limited, there have been several studies noting multidrug
resistant tuberculosis, methicillin-resistant Staphylococcus
aureus, and resistance of V. cholera to tetracycline
and H.
pylori to amoxicillin and tetracycline. The most up-to-date
surveillance analysis of antibiotic resistance in Nepal is being
conducted by APUA with a pilot recently completed in the
summer of 1997. These results are being compiled and will be
presented at the American Society for Microbiology meeting in
May. Information on antibiotic supply and distribution and
resistance patterns is minimal.
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