This document summarizes a seminar on antimicrobial resistance in Nepal. It discusses how antimicrobial resistance is a major public health issue as it can render treatments ineffective and allow infections to spread. It provides examples of resistant bacteria like MRSA. It then covers factors contributing to resistance like overuse of antibiotics in humans, animals, and the environment. The challenges of resistance in Nepal are outlined, such as poverty and lack of awareness. Finally, it proposes mitigation strategies including only using antibiotics when prescribed, reducing unnecessary use in animals, and addressing the issue in Nepal's public health system.

1. Seminar on
Antimicrobial resistance: Current scenario, future challenges and mitigating strategies
in Nepalese context
Theme: Issue in public health
Under cardinal guidance of
Dr. Hari Prasad Kaphle
Assistant Professor
SHAS, PU
By
Ashrita Subedi
2015-1-37-0007
At
School of health and allied Science
Pokhara University, Dhungepatan, Pokhara
2019
9/28/2019
1

2. Introduction
Antimicrobial resistance (AMR) is the ability of a microorganism
(bacteria, viruses and some parasites) to stop an antimicrobial
(antibiotics, antivirals,antimalarials) from working agents it.
Standard treatment become ineffective, infections persist and may
spread to others.
9/28/2019
2

3. Cond….
This is responsible for millions of death worldwide and is
considered as a major public health concern nowadays.
Antimicrobial resistance (AMR) threatens the effective
prevention and treatment of an ever increasing range of
infections caused by the microbes
The cost of health care for patients with resistant
infections is higher
9/28/2019
3

4. Examples of AMR
Bacteria that are resistance to antibiotic include
methicillin-resistance, Staphylococcus aureus
(MRSA), Penicillin-resistance Enterococcus, and
multidrug-resistance Mycobacterium tuberculosis
(MDR-TB), which is resistance to tuberculosis
drugs, Isoniazid and rifampicin
9/28/2019
4

5. Why resistance is a concern
Resistant organisms lead to treatment failure
Increased mortality
Resistance bacteria may spread in community
Low level resistance can go undetected
Added burden of health care costs
Threatens to return to pre-antibiotic era
9/28/2019
5

6. 9/28/2019
6

7. Factors of antibiotic resistance
Drug related factors
Environmental factors
Prescriber related factors
Patient related factors
9/28/2019
7

8. Drug Related
Over the counter availability of antimicrobials
Irrational fixed dose combination of antimicrobials
Soaring use of antibiotics
9/28/2019
8

9. Environmental factors
Huge populations and overcrowding
Rapid spread by better transport facility
Poor sanitation
Increased community acquired resistance
Ineffective infection control program
Widespread use of antibiotics in animal husbandry and
agriculture and as medication cleansing products
9/28/2019
9

10. Patient Related
Poor knowledge of dosage regimens
Poverty
Lack of sanitation concept
Self- medication
Misconception
9/28/2019
10

11. Prescriber Related
Inappropriate use of available drugs
Increased empiric poly-antimicrobial use
Overuse of antimicrobials
Inadequate dosing
Lack of current Knowledge and training
9/28/2019
11

12. Antimicrobial resistance Scenario

13. Source: frontiersin.org

14. Challenges of Antimicrobial resistance
emergence of newer MDR organisms pose newer
diagnostic and therapeutic challenges
poverty, illiteracy, overcrowding and malnutrition further
compound the situation
Lack of awareness about infectious diseases
self-prescription of antimicrobial agents
Low doctor to patient and nurse to patient ratios
9/28/2019
14

15. Contd…
rise in the pharmaceutical sector increase waste from
companies
lack of strict supervisory and legal actions
Use of antimicrobial agents as pesticides and insecticides
in the agriculture industry
Uncontrolled sale in many low or middle income
countries
9/28/2019
15

16. Condt…
36% of individuals with cold or an upper respiratory
infections were given prescription for antibiotic
9/28/2019
16

17. Mitigation strategies
WHO recommended that farmers and food industry stop
using antibiotics
Preserve the effectiveness of antibiotics by reducing their
unnecessary use in animals
Strong sustained action across all sectors is vital if we are
to turn back the tide of antimicrobial resistance.
Consumers and supliers drive the major food chains
adopting antibiotic-free policies.
9/28/2019
17

18. Condt…
Alternative options to using antibiotics for disease
prevention in animals
Preserve the effectiveness of the most critical antibiotics
for medicine
Use of antibiotics only when prescribed by a doctors
No sharing of antibiotic with others or using lefeover
prescriptions
9/28/2019
18

19. Condt…
Nepal has made important advances in reducing mortality
and morbidity and increase health coverage, but has not
yet taken steps to address antibiotic resistance.
9/28/2019
19

20. References
Adhikari s.,saud b, Paudel G. Emergence of Antimicrobial
Drug Resistance Bacteria in Nepal: A current Scenario
February 2019;10(8).
World Health Organization: Antimicrobial resistance,2016-
Geneva,swizerland.
Acharya KR. Antimicrobial residue and Prevalence of
Indicators bacteria Having Antimicrobial Resistance
Isolated from Marked poultry in Kathmandu, Nepal.(2011)
9/28/2019
20

21. Condt…
Shrestha k. Potential Antimicrobial Resistance Threat-
Nepal.(Accessed july 22, 2018)
VSDAO 2067/68 B.s. Annual Technical Report.
(2016)(accessed january19,2018)
9/28/2019
21

22. Thank You!!!
9/28/2019
22