Besides the regular bout of flu every time the season changes, Anjali Pant, 33, suffers from a persistent cough throughout the year. The sore-throat syndrome has become an extension of her personality, as she jokingly puts it. What used to be easily cured by popping a few antibiotics some years ago just doesn’t seem to go away now, and Pant is in a quandary about how to tackle the seemingly trivial but annoying health issue.[break]
“If I had a sore throat, I would go to the pharmacy and ask for Erythromycin, and in a few days’ time the symptoms would vanish,” says Anjali who has been taking the drug ever since she was in her early twenties.[break]
She didn’t even have to visit the doctor for a prescription because the medicine was easily available over the counter and still is.
“My mother used to take Erythromycin for sore throat and I did the same without giving it much thought,” she says, adding that the medicine has lost its efficacy now and doesn’t help at all.
Casual use of antibiotics is the leading cause of increased drug resistance in Nepalis in recent times. (Photo: Bijay Gajmer/Republica)
Misuse of over-the-counter drugs, especially antibiotics, is leading to drug resistance among the Nepalis, says Dr Mahesh Raj Ghimire, medical officer at the Emergency Department at Sumeru Hospital in Dhapakhel.Antibiotic resistance leads to health and financial problems. As drugs become increasingly ineffective against certain types of bacteria, the illness is prolonged and additional treatments are required.
“Patients opt for antibiotics without consulting experts and without thinking about the long-term side effects and repercussions. Sometimes they even have a tablet or two and don’t complete the full course when the symptoms start to subside,” says Dr Ghimire, explaining that not completing the course of an antibiotic will also lead to resistance over time.
One of the common misconceptions among people is that they have to take antibiotics when they have an attack of cold or flu. But antibiotics aren’t helpful in infections caused by viruses, and in cases like seasonal cold and flu simple over-the-counter medications that help to ease headaches and aching muscles will suffice.
Irrational self-administration, due to the drugs being available without prescription, is one of the main reasons for drug resistance in Nepalis. Also inadequate monitoring on the government’s part adds to the problem.
Though the National Drug Policy 1995 has made careful use of antibiotics one of its major points and states that supervision and monitoring of the use of antibiotics will be carried out, pharmacies in the Valley still dispense antibiotics without prescriptions.
According to a BBC report, resistance to antibiotics is one of the greatest threats to modern health around the world. Many antibiotics are being used unnecessarily for mild infections, helping to create resistance.
To prevent misuse and abuse of drugs, it has been classified into three categories according to their constituents, efficacy and use, as per Drug Standard Regulation with the provision of Section 17 of the Drug Act 1978.
Antibiotics fall in the group of prescriptive drugs to be sold only on the advice of a registered medical practitioner. However, in a developing nation like Nepal, nearly all antibiotics are available over the counter.
Saraswati Gautam, pharmacist at Thapathali Pharmacy, admits that antibiotics make up 30% of daily sales at the dispensary. Mohan Rohita, pharmacist at Prakritik Pharmacy at Alka Hospital, Pulchowk, also confesses that antibiotics are dispensed without prescriptions since most people just come and ask for specific ones while Nijan Upadhaya, another pharmacist at the same outlet, adds that they do inquire about the patients’ symptoms before making the drugs available to them.
“It’s true that most patients just ask for antibiotics straight away and while a prescription isn’t mandatory for it, we try to make them aware that they don’t have to take antibiotics for minor illness,” says Nijan before owning up that they do give antibiotics when persuasion fails.
Bijay Gajmer/Republica
Kabi Raj Khanal, vice spokesperson at the Ministry of Health and Population, says that the Department of Drug Administration (DDA) is responsible for the monitoring and supervision of the sales of antibiotics but since it lacks the required manpower, control and management are not being carried out effectively.
“I think all three parties – the consumers, pharmacies, and government – are to blame regarding this issue. Consumers shouldn’t use the drugs recklessly, the pharmacies shouldn’t sell it to people without prescriptions and the government needs to run awareness campaigns and implement policies regarding the sales of drugs,” says Khanal.
The vice spokesperson says the government is aware of the pressing matter and the side effects like multi-drug resistance associated with imprudent and long-term use of antibiotics but also admits that they have not been able to deal with the issue effectively.
“I believe strengthening the DDA by increasing its manpower would prove to be useful in tackling the concern. The government (we) need to come up with a sustainable policy that can be implemented and not just be limited to paperwork,” he says.
According to Khanal, sometimes the people under whose name a pharmacy is registered sell it to someone else who lacks the training of running a pharmacy, and in cases like those there are higher chances of drugs being dispensed heedlessly. He says that even this needs to be monitored to curb the sales of drugs not prescribed.
According to a study carried out by Dr. Geeta Shakya of National Public Health Laboratory (NPHL) on the resistance surveillance in Nepal, bacteria like Vibrio Cholera and those of Shigella species responsible for diarrheal diseases have become more resistant to antibiotics in recent years.
Amoxicillin is one of the most common antibiotics prescribed for children, and its resistance has gone up from 62% in 2005 to 100% in 2010, and co-trimoxazole resistance has shot up to 100% for both Vibrio Cholera and Shigella species.
Experts believe that if this continues, then we are headed towards a future with no cure for infections. “Emergence of multi-drug resistance has limited therapeutic options. If antibiotics aren’t used responsibly, then there’ll be no remedy for diseases in the near future,” concludes Dr Ghimire.
The writer can be reached at cillakhatry@gmail.com.
Related story
Dr Sah arrested on charge of sexual assault against female doct...
_20220818114341.jpg)
