Antibiotics Prescription, Dispensing Practices and Antibiotic Resistance Pattern in Common Pathogens in Nepal: A Narrative Review

Abstract

Antimicrobial resistance (AMR) is increasing and it is a serious public health problem worldwide. Nepal is considered as one of the contributors for rising AMR due to the most prevalent irrational use of antibiotics. In this review, we have assessed the practices of antibiotic prescription and dispensing, and antibiotic resistance of commonly encountered bacteria in Nepal. There is exponential increase of therapeutic consumption of antibiotics either without clinician’s prescription or irrational prescription. Almost half of the population in Nepal was found to purchase antibiotics easily from the nearby pharmacies without clinician’s prescription. Irrational prescription is exceeded in remote areas which could be due to lack of access with health posts and hospitals. The third generation cephalosporins, which are considered as the last resort antibiotics were found to be relatively prescribed and dispensed higher as compared to other classes of antibiotics. Despite the existing limited functional surveillance system, antibiotic resistance among bacteria is increasing in Nepal because of irrational prescription, dispensing and consumption of antibiotics without prescription.

Antimicrobial Prophylaxis in Surgery: A Cross-Sectional Study in the Surgical Ward of a Tertiary Care Centre in Central Nepal

“…NATG recommends antibiotic prophylaxis for organisms most likely to cause post-operative infection and not to cover all likely contaminants. Nevertheless, the practice of administering empirical antimicrobials especially third generation cephalosporins is very high in Nepal at community level 14,19 but this study reports similar practice at tertiary care hospitals as well. This unnecessarily broader use of antimicrobials at tertiary level could further contribute to growing antibiotics resistance in Nepal.…”

Identification, antimicrobial resistance and molecular detection of Shiga toxin-producingE. coli(STEC) isolated from raw milk of cattle in Chitwan, Nepal

“…The results of our study also show varying frequency of antibiotic sensitivity patterns of E. coli and STEC in milk as compared to reports of other researchers (22, 65). The prevalence of antibiotic resistance can vary widely based on factors such as antibiotic availability, cost, and the responsible use of these drugs in various parts of the world (76, 77). The differences could also be due to different biochemical and genotypic properties of bacteria, that lead to drug resistance and it spread among different genera and species is mediated by horizontal gene transfer (78, 79).…”