Antibiotic efficacy towards zero, 25 laboratories collecting data on antibiotic resistance

Kathmandu. It has been observed that the effectiveness of antibiotics is decreasing in poor countries. Antimicrobial resistance has started to increase as antibiotics stop working, experts say.

Dr. Satish Deo, associate professor at Department of Clinical Pharmacology, Tribhuvan University Teaching Hospital said that the effectiveness of antibiotics is reaching zero and the country will have to suffer a huge loss during that period.

According to various studies in Nepal, the sale of antibiotics without a doctor’s prescription has reached 50 per cent. Also the prescription rate of antibiotics is 50.4 per cent. Similarly, the prescription rate is 52.2 per cent in health posts.

“This is a very dangerous situation,” said Dr. Meghraj Banjara, former head of Microbiology Department at Tribhuvan University Teaching Hospital.

Dr. Banjara said, “67 to 97 per cent of people buy antibiotics without consulting medical practitioners. The pharmacies also sell the antibiotics without doctors’ recommendation. The rate of sales from the pharmacies is 50 per cent.”

Sales of antibiotics without doctors’ prescription, shopkeepers selling antibiotics without knowledge, and people asking for antibiotics themselves in poor countries are some of the causes for antimicrobial resistance.

After the antibiotics stopped working data collection on bacteria and their antibiotic resistance has been started from 25 laboratories from across the country. Data collection on bacteria and antibiotic resistance on animals has also been started. The data collection is being done from seven laboratories.

The central laboratory will conduct a survey of 10 bacteria from 25 labs. Livestock laboratory will survey four bacteria.

The National Public Health Laboratory is conducting the survey on humans while the Central Livestock Disease Research Laboratory is conducting the survey on animals. The laboratories will make an antibiogram after the data collection. The laboratories will find out which antibiotic works on which bacteria and which not. The hospitals should send reports and samples of the patients under treatment to the laboratory.

Various organisms are changing themselves to withstand the environmental pressure. During treatment antibiotics are used to kill organisms. However, when the necessary doses of antibiotics are not available the organism develops the ability to fight with antibiotics.

Doctors say, “If the dose of antibiotics taken by a person is not enough to kill bacteria, it increases the resistance. This is how bacteria become resistant to antibiotics.”

In order to resist antibiotic bacteria must compromise on something. On the one hand, they change their cells and on the other they compromise. Whenever the pressure of the antibiotics stops on bacteria they gradually return to their natural state.

Antibiotics have been developed since many years. No new antibiotics have been developed in the last 35 years. Linezolid was the last one developed in 1987.

The World Health Organization had introduced the Global Action Plan on Antimicrobial Resistance with an aim that the countries across the globe could develop a special strategy on bacteria.

Taking this into consideration Nepal has also made a National Antimicrobial Resistance Containment Action Plan. But it has not been approved by the government. Dr. Madan Upadhyay, head of the Quality Measurement and Monitoring Division says that the plan is under the process of being passed.

The National Action Plan on Antimicrobial Resistance has adopted five strategies. The health ministry says that though the plan has not been passed the work has not been stopped. Lumbini Province has also made a regional action plan on antimicrobial resistance. Unfortunately, this too has not been passed.

Bacteria are not only in humans. They are in animals, food and environment. When the waste produced by the industries are mixed in sewages without treatment the bacteria there too become resistant.

Causes for antibiotic resistance

Antibiotics are used in animals. It is used especially in chicken. Dr. Banjara says that antibiotic resistant is getting inside the human body while consuming chickens. The causes for a rise in antibiotic resistance in Nepal are – People take antibiotics and also the bacteria in the human body are becoming antibiotic resistant. This is the main problem of poor countries.

Dr. Deo also says that there are no registered pharmacists in the pharmacies. There are incidences that the distribution and sales of the medicines are done by someone else than the one whose certificate is hung on the pharmacy. There are no options than to stop it.

According to Dr. Banjara currently there is not even one doctor per 1000 patient in Nepal. Of the doctors available in the service the ratio is 0.17. The World Health Organization states that there should be 2.3 doctors per 1000 population. There is a lack of trained health personnel in remote areas and paramedics and health assistants are giving services. It is a great thing that they are delivering the services but the government should provide guidelines in their hands. Rather than ignoring the services they provide we should help them.

What do researches say?

Dr. Banjara says, “The antibiotic prescription rate is 50.4 percent in rural areas. Health post has 52.2 percent

The World Health Organization has divided antibiotic use into three stages. Use access group of medicine for the first time. If this does not work then give the medicine from watch group. If none of these work then give the medicines from reserve group of antibiotics. However, in Nepal antibiotic drugs of the second group are being used more than they should be kept in the watch group.

Dr.Banjara says, “There is a lack of knowledge among health workers. When using antibiotics, they should be informed about which one should be used first and in which case, the second and third ones should be used.”

Now there is a situation where three or more antibiotics do not work. Most of the antibiotics do not work. There are also situations when none of the antibiotics work. There are no records on how many people die due to antibiotic resistance.

However, according to World Health Organization estimates 700,000 people die across the world in a year due to antibiotic resistance. But there is no data on how many people become ill and die in Nepal because of antibiotic resistance.