In countries around the world,
the misuse and overuse of antibiotics have led to the emergence of
antimicrobial resistance (AMR), a grave threat to public health. This
"unnatural selective pressure" on bacteria is fueling the rise of
drug-resistant superbugs, resulting in an estimated 1.3 million deaths in 2019
alone. If we fail to take action, projections suggest that AMR could claim 10
million lives annually by 2050, equating to one life lost every three seconds.
Nepal, like many other nations,
faces the pressing challenge of AMR. The misuse of antibiotics has serious
consequences, creating a dangerous dependence on these drugs and fostering
highly resistant strains of bacteria. These developments undermine the progress
made in medical advancements, rendering the once-effective antibiotic
treatments obsolete.
The situation is exacerbated by
the fact that Nepal, despite being a relatively small country, has a high burden
of antibiotic consumption. Although comprehensive data on antibiotic
consumption in Nepal is limited, studies indicate that the quantity of
antibiotics consumed is a cause for concern. Furthermore, the type of
antibiotics being consumed is also alarming, with a significant prevalence of
broad-spectrum antibiotics, including those recommended for restricted use.
While regulations theoretically
require the purchase of antibiotics with a prescription, the reality in Nepal
tells a different story. Many sales occur without a formal prescription from a
qualified healthcare provider. Qualitative studies conducted in various regions
of Nepal have found antibiotics to be readily available over-the-counter (OTC)
in retail pharmacies, echoing similar concerns from neighbouring countries. Of
particular worry is the dispensation of antibiotics by unqualified providers,
inappropriate prescriptions, and the demand from patients seeking to
self-medicate through OTC services. The lack of awareness among the general public
and healthcare professionals about the impact of such practices on the
evolution of AMR further compounds the issue.
To address the spread of AMR
effectively, Nepal must invest in preventive actions that promote responsible
antibiotic use and impede the evolution of drug-resistant bacteria. This
necessitates tackling longstanding structural limitations and improving access
to primary healthcare services, including diagnostics. Diagnostics play a
crucial role as the first step in any clinical care pathway. They not only help
determine the nature of the infection (bacterial or viral) but also guide
clinical decision-making, thereby reducing unnecessary prescriptions,
optimizing antibiotic use, and generating valuable data for disease
surveillance and public health interventions.
In essence, by enhancing access
to diagnostics at the primary level of care, where patients initially seek
treatment, Nepal can help reduce the demand for off-prescription antibiotics
and break the cycle of dependency. In the context of AMR diagnostics in Nepal,
this means:
- Creating awareness-raising campaigns that educate
the public and healthcare professionals about the importance of seeking
professional care and safeguarding the appropriate use of antibiotics.
- Supporting the development of rapid point-of-care
testing devices that bring essential diagnostic tests closer to where
people live and work.
- Developing electronic tools that aid clinical
decision-making, guiding the rational use of both existing and new antibiotics.
- Establishing an evidence-based approach to disease
surveillance, informing local and national policies for AMR control.
Addressing AMR requires a
collective effort from all stakeholders. Breaking down silos and fostering
collaboration across disciplines and borders is crucial to co-create solutions
that protect both individual and public health. Failure to safeguard and
rationalize the use of antibiotics jeopardizes their efficacy, putting us at
risk of losing these critical drugs. To safeguard our future, it is imperative
that we invest in AMR diagnostics today.
Nepal has a significant
opportunity to take a proactive stance in the fight against AMR. By
implementing comprehensive strategies and initiatives focused on responsible
antibiotic use and enhanced access to diagnostics, Nepal can safeguard its
population from the threats posed