December 31, 2014
The Global Antibiotic Resistance Partnership-Nepal (GARP-Nepal) working group, based at the Nepal Public Health Foundation, released the first fully documented situation analysis of antibiotic resistance and related factors in Nepal on December 15 in Kathmandu. The working group consists of Nepali experts in medicine, veterinary science, pharmacology, microbiology, economics and other fields.
The situation analysis revealed to the assembled dignitaries (including the Minister of Health and Population), clinicians, veterinarians, microbiologists, and others that the problem in Nepal is not just something to worry about in the future—it is here already and getting worse.
However, the seriousness of the situation may not be the most important lesson from the situation analysis or the meeting. More important is expanding the definition of the drivers of antibiotic resistance and the remedies. Hardly anyone in Nepal, including healthcare workers, would equate better vaccination coverage with saving antibiotics. Yet once pointed out, the connection is crystal clear: a child who doesn’t get sick is not given antibiotics (this includes both necessary and irrational prescribing). Perhaps the antibiotic angle is overlooked because we don’t need a rationale for vaccines besides their primary purpose of preventing disease. Similarly, clean water and sewerage can dramatically reduce infection, especially diarrhea in children. And again, saving antibiotics is not the primary motivation to support these improvements, but it should be registered as an added benefit.