The Open Microbiology Journal




ISSN: 1874-2858 ― Volume 13, 2019
LETTER

Prevent Misuse of Antibiotics in Nepal



Krishna P. Acharya1, *, Sarita Phuyal2, Niranjan Koirala3
1 Animal Quarantine Office, Budhanilakantha, Kathmandu, Nepal
2 Central Referral Veterinary Hospital, Tripureshwar, Kathmandu, Nepal
3 Department of Natural Products Research, Dr. Koirala Research Institute for Biotechnology and Biodiversity, Kathmandu, Nepal


Article Information


Identifiers and Pagination:

Year: 2019
Volume: 13
First Page: 239
Last Page: 240
Publisher Id: TOMICROJ-13-239
DOI: 10.2174/1874285801913010239

Article History:

Electronic publication date: 30/09/2019
Collection year: 2019

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© 2019 Acharya et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: (https://creativecommons.org/licenses/by/4.0/legalcode). This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


* Address correspondence to this author at the Animal Quarantine Office, Budhanilakantha, Kathmandu, Nepal; E-mail: Krishna.acharya@nepal.gov.np, kriaasedu@gmail.com





Antibiotics consumption is quite high in health care settings of Nepal [1Acharya KP, Wilson RT. Antimicrobial Resistance in Nepal. Front Med (Lausanne) 2019; 6(May): 105.
[http://dx.doi.org/10.3389/fmed.2019.00105] [PMID: 31179281]
, 2Basnyat B, Pokharel PK, Mani Dixit S, Karkey A, Shrestha B, Thapaliya S, et al. GARP-Nepal national working group (NWG) 2014; 1-20.]. Antimicrobial resistance (AMR) is a growing problem resulting in heavy loss and economic burden [1Acharya KP, Wilson RT. Antimicrobial Resistance in Nepal. Front Med (Lausanne) 2019; 6(May): 105.
[http://dx.doi.org/10.3389/fmed.2019.00105] [PMID: 31179281]
, 2Basnyat B, Pokharel PK, Mani Dixit S, Karkey A, Shrestha B, Thapaliya S, et al. GARP-Nepal national working group (NWG) 2014; 1-20.]. Though no comprehensive nationwide study exists, various studies have shown that resistant microbes are rampant in animal and human health sector [1Acharya KP, Wilson RT. Antimicrobial Resistance in Nepal. Front Med (Lausanne) 2019; 6(May): 105.
[http://dx.doi.org/10.3389/fmed.2019.00105] [PMID: 31179281]
-3Zellweger RM, Basnyat B, Shrestha P, et al. Changing antimicrobial resistance trends in kathmandu, nepal: A 23-year retrospective analysis of bacteraemia. Front Med (Lausanne) 2018; 5: 262.
[http://dx.doi.org/10.3389/fmed.2018.00262] [PMID: 30283784]
]. This crisis of AMR is closely linked to the availability of antibiotics over the counter without prescription, irrational use, failure to follow prescribed course of antibiotics, lack of effective surveillance system and antimicrobial stewardship in animal and human health sector [2Basnyat B, Pokharel PK, Mani Dixit S, Karkey A, Shrestha B, Thapaliya S, et al. GARP-Nepal national working group (NWG) 2014; 1-20., 4Dahal RH, Chaudhary DK. Microbial infections and antimicrobial resistance in nepal: Current trends and recommendations. Open Microbiol J 2018; 12(1): 230-42.
[http://dx.doi.org/10.2174/1874285801812010230] [PMID: 30197696]
], and widespread overuse of antibiotics as growth promoter in animal feed [1Acharya KP, Wilson RT. Antimicrobial Resistance in Nepal. Front Med (Lausanne) 2019; 6(May): 105.
[http://dx.doi.org/10.3389/fmed.2019.00105] [PMID: 31179281]
, 5Basnyat B. Situation analysis and recommendations: Antibiotic use and resistance in nepal. 2015.]. In addition, culture and antibiotics sensitivity facilities are not available in many health care settings [6WHO. Resource mobilisation for antimicrobial resistance ( AMR ): Getting AMR into plans and budgets of government and development partners Nepal country level report. 2018; 1-34., 7Mishra SK, Tiwari BR, Yadav BK. Status of pathology professionals. J Nepal Health Res Counc 2012; 10(1): 37-40.
[PMID: 22929635]
], as a result, antibiotics are mostly prescribed syndromically [8Shrestha S, Yadav RS, Deo SK. Burgeoning irrational antibiotics use in primary health care in nepal. J Nepal Health Res Counc 2019; 16(41): 473-5.
[PMID: 30739919]
]. Furthermore, poor infection control system and poor sanitation and hygiene have further added to the problem of AMR in Nepal [1Acharya KP, Wilson RT. Antimicrobial Resistance in Nepal. Front Med (Lausanne) 2019; 6(May): 105.
[http://dx.doi.org/10.3389/fmed.2019.00105] [PMID: 31179281]
, 9WHO. Global Learning Event Water, sanitation and hygiene in health care facilities: Action-oriented solutions and learning Meeting Report 2 Contents. 2017.].

Laws exist regarding the prudent use of antibiotics [10MoHP. National Antibiotic Treatment Guidelines-2014. 2014., 11MoH. NATIONAL ANTIMICROBIAL RESISTANCE CONTAINMENT ACTION PLAN NEPAL 2016; 2016: 1-24.] and infection control systems in Nepal [11MoH. NATIONAL ANTIMICROBIAL RESISTANCE CONTAINMENT ACTION PLAN NEPAL 2016; 2016: 1-24.], but the problem lies with implementation, as for example, antibiotic treatment guidelines-2014 issued by curative division of Ministry of Health and Population (MoHP), but has hardly been followed [6WHO. Resource mobilisation for antimicrobial resistance ( AMR ): Getting AMR into plans and budgets of government and development partners Nepal country level report. 2018; 1-34.]. The poor implementation and non-compliance to standard guidelines have facilitated increased emergence and transmission of drug resistant microbes [2Basnyat B, Pokharel PK, Mani Dixit S, Karkey A, Shrestha B, Thapaliya S, et al. GARP-Nepal national working group (NWG) 2014; 1-20., 6WHO. Resource mobilisation for antimicrobial resistance ( AMR ): Getting AMR into plans and budgets of government and development partners Nepal country level report. 2018; 1-34.]. The above mentioned conditions warn that Nepal is not prepared enough to detect, prevent and respond to the threat of AMR. However, it is not too late. The Government of Nepal (GoN) should prioritize AMR and adopt rigorous AMR action plan that includes: 1) Development of laboratory networks to quickly detect, report and respond. 2) Development and imple-mentation of rigorous surveillance system 3) Development of qualified manpower to do surveillance, test sample and perform data analysis 4) Creating an enabling environment to engage physicians, veterinarians and other community members to promote the prudent use of antibiotics, personal hygiene, sanitation, and vaccination.

Controlling AMR is difficult but feasible, which needs a high level of political, social and economic commitment.

CONFLICT OF INTEREST

The authors declare no conflict of interest, financial or otherwise.

ACKNOWLEDGEMENTS

The authors would like to thank the author Dr. Krishna Kaphle for his technical guidance in the preparation of this manuscript.

REFERENCES

[1] Acharya KP, Wilson RT. Antimicrobial Resistance in Nepal. Front Med (Lausanne) 2019; 6(May): 105.
[http://dx.doi.org/10.3389/fmed.2019.00105] [PMID: 31179281]
[2] Basnyat B, Pokharel PK, Mani Dixit S, Karkey A, Shrestha B, Thapaliya S, et al. GARP-Nepal national working group (NWG) 2014; 1-20.
[3] Zellweger RM, Basnyat B, Shrestha P, et al. Changing antimicrobial resistance trends in kathmandu, nepal: A 23-year retrospective analysis of bacteraemia. Front Med (Lausanne) 2018; 5: 262.
[http://dx.doi.org/10.3389/fmed.2018.00262] [PMID: 30283784]
[4] Dahal RH, Chaudhary DK. Microbial infections and antimicrobial resistance in nepal: Current trends and recommendations. Open Microbiol J 2018; 12(1): 230-42.
[http://dx.doi.org/10.2174/1874285801812010230] [PMID: 30197696]
[5] Basnyat B. Situation analysis and recommendations: Antibiotic use and resistance in nepal. 2015.
[6] WHO. Resource mobilisation for antimicrobial resistance ( AMR ): Getting AMR into plans and budgets of government and development partners Nepal country level report. 2018; 1-34.
[7] Mishra SK, Tiwari BR, Yadav BK. Status of pathology professionals. J Nepal Health Res Counc 2012; 10(1): 37-40.
[PMID: 22929635]
[8] Shrestha S, Yadav RS, Deo SK. Burgeoning irrational antibiotics use in primary health care in nepal. J Nepal Health Res Counc 2019; 16(41): 473-5.
[PMID: 30739919]
[9] WHO. Global Learning Event Water, sanitation and hygiene in health care facilities: Action-oriented solutions and learning Meeting Report 2 Contents. 2017.
[10] MoHP. National Antibiotic Treatment Guidelines-2014. 2014.
[11] MoH. NATIONAL ANTIMICROBIAL RESISTANCE CONTAINMENT ACTION PLAN NEPAL 2016; 2016: 1-24.

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