Widespread Antibiotic Resistance Presents Growing Crisis for Global Health
In recent years, the issue of antibiotic resistance has escalated, posing a significant threat to global health. Nepal, in particular, is facing a growing crisis as the effectiveness of antibiotics, even for major diseases like typhoid fever, continues to decline. The alarming rise in antimicrobial resistance is not limited to typhoid fever but extends to various other health conditions as well.
One of the potential drivers of this crisis is the widespread use of antibiotics, particularly in livestock and poultry farming. This practice has contributed to the development of antibiotic-resistant bacteria, rendering many commonly used antibiotics ineffective. For instance, ampicillin, previously relied upon for treating typhoid fever caused by Salmonella Typhi, has lost its effectiveness over time. Substituting it with ciprofloxacin also proved to be insufficient in combating the disease. Currently, doctors in Nepal prescribe amoxicillin, but even this antibiotic’s effectiveness against typhoid fever has dropped to a mere 15 percent, according to the National Public Health Laboratory.
Public health experts in Nepal have been sounding the alarm, referring to this issue as a silent pandemic that has the potential to render antimicrobials completely ineffective if left unaddressed. Dr. Madan Upadhyay, the chief of the Policy Planning and Monitoring Division at Nepal’s Ministry of Health and Population, emphasizes the grave consequences of growing resistance rates, warning that many lives could be at risk. This issue is no longer silent and is causing serious problems in the country.
According to the World Health Organization (WHO), antimicrobial resistance occurs when bacteria, viruses, fungi, and parasites evolve and no longer respond to available medicines. This poses significant challenges in treating infections, increases the risk of disease spread, and escalates the severity of illness and death rates. As a result, the ineffectiveness of medicines allows infections to persist in the body, further enhancing the risk of spreading them to others.
In Nepal, the easy availability of antibiotics without prescription exacerbates the problem. Many individuals purchase antibiotics over the counter, often without disclosing their specific ailment to pharmacists. Pharmacists themselves frequently fail to inquire about the condition or emphasize the importance of completing the full course of medicine. Experts believe this is a major reason behind the increasing rate of antimicrobial resistance.
Another contributing factor is the prescription of antibiotics based on clinical diagnosis, even before laboratory test reports are obtained. Antibiotics are not effective in treating viral infections, yet doctors often prescribe them prior to confirmation. A 2021 study conducted by the Nepal Health Research Council reveals that only 32 percent of doctors and health workers have access to laboratories for antibiotic susceptibility testing. Among them, just 49 percent recommend such testing before prescribing antibiotics, meaning a mere 16 percent of doctors prescribe antibiotics based on susceptibility testing.
The study also highlights that over one-third of prescribed medicines in Nepal are antibiotics, surpassing the World Health Organization’s recommended standards. Additionally, a significant number of outpatients do not complete a full course of antibiotics, either consuming them as prophylaxis or taking double doses for faster recovery. Almost a quarter of patients save residual antibiotics for future treatment, unaware that incomplete courses may render the same antibiotic ineffective the next time. Shockingly, about 28 percent of outpatients admitted to purchasing antibiotics without prescriptions.
Dr. Ranjan Bhatta, the director at the National Public Health Laboratory, emphasizes that antimicrobial resistance affects every one of us in some way, leading to increased morbidity and mortality rates, not only in Nepal but worldwide.
While human antibiotic use contributes to resistance, the agricultural sector is also a significant driver. The widespread use of antibiotics in livestock and poultry production contributes to the prevalence of antibiotic-resistant bacteria in meat and poultry products. Moreover, resistant organisms are released from farms into soil, groundwater, and surface waterways, contaminating water sources used for crop irrigation and domestic purposes. Farmers often resort to using multiple antibiotics without a proper understanding of the disease, further fueling antimicrobial resistance.
The study conducted by the Nepal Health Research Council sheds light on the lack of awareness, availability of national guidelines, and infrastructure for prescribing antibiotics and recommending susceptibility tests in both human and animal health professions.
As the crisis of antimicrobial resistance continues to escalate, urgent action is needed on various fronts. Efforts should focus on raising public awareness about the appropriate use of antibiotics, restricting their availability without prescription, and emphasizing the importance of completing the full course of treatment. A comprehensive approach is necessary to tackle the complex issue of antibiotic resistance, encompassing human and animal health sectors, as well as stringent regulations for the agricultural use of antibiotics. Failure to address this crisis could have devastating consequences for global health and leave us defenseless against many infectious diseases.
