Status of Resistance
The most urgent antibiotic resistance problems identified by the APUA Nepal members are:
- Lack of regulation in human use
- Lack of regulation in agricultural use
- Lack of surveillance of antibiotic use and resistance
- Lack of updated antibiotic use and treatment guidelines
- Lack of continuing medical education on antibiotic use for prescribers
- S. enterica serotype Typhi and Paratyphi, TB
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 was conducted by APUA with a pilot completed in the summer of 1997. These results were compiled and presented at the American Society for Microbiology meeting. Information on antibiotic supply and distribution and resistance patterns is minimal.
Chapter Objectives and Priorities
- To develop and submit Antibiotic Treatment Guidelines by APUA-Nepal to the Ministry of Health and Population
- Drafted antibiotic policy for the country at a very early stage after registration of the chapter with the government as a NGO. Antibiotics strategies that we drafted were also incorporated into the existing National Drug Policy in 1995.
- Drafted Nepal National Antibiotic Treatment Guidelines and submitted them to the Ministry of Health and Population (MoHP) for approval. Awaiting response.
- Publishing the APUA-Nepal Newsletter every year since 2004. APUA-Nepal has released sensitivity patterns of common isolates in urine, blood and pus samples from different levels of hospitals in Nepal. Although they do not have funds to support the data collection; rather, the motivation for a source to make data available to them is receiving acknowledgement in their Newsletter. The Newsletter is distributed to prestigious teaching hospitals and other hospitals at different levels of healthcare in the country. The APUA Nepal Newsletter-2013 is available online.
- Published an article on "Antimicrobial resistance at different levels of health care services in Nepal" in the Regional Health Forum, published by SEARO/WHO on World Health Day 2011.
- Development a curriculum and training materials on "Rational use of antimicrobials for fresh medical graduates," a problem-based approach developed with the contributions of senior faculty from medical schools and senior health professionals. There has been a demand to train more groups, but the chapter could not continue it due to shortage of funds needed to revise the training materials, support trainers, and provide other logistical support.
- Publication of posters and brochure for improving community awareness on antibiotic use.
Chapter President: Dr. Kumud K. Kafle, Professor and Head of Clinical Pharmacology, Institute of Medicine, T. U. Teaching Hospital, Kathmandu, Nepal
Chapter Vice President: Dr. Asaq Sheak
General Secretary: Dr. Bharat M. Pokhrel, Professor and Head of Microbiology, Institute of Medicine, T.U. Teaching Hospital, Kathmandu, Nepal
Treasurer: Ms. Kalpana Shrestha