Kathmandu: The Department of Drug Administration in Nepal has taken a significant step in the fight against antibiotic resistance by banning the use of 103 combinations of antibiotics that are not recommended by the World Health Organization (WHO). This move by the national drugs regulator aims to address the alarmingly high levels of antibiotic resistance prevalent in the country.
Director General of the Department of Drug Administration, Narayan Dhakal, clarified the scope of the ban, stating, “We have not restricted the use of any individual antibiotics. Only the use of combinations of two or more antibiotics is prohibited. Combination antibiotics are being used widely in many countries, including Nepal, and studies show irrational use of combination antibiotics increases antibiotic resistance.”
Of the 103 banned combinations, 14 are currently in use within Nepal. These include amoxicillin/cloxacillin, ampicillin/cloxacillin, ampicillin/dicloxacillin, benzylpenicillin/streptomycin, cefepime/sulbactam, cefixime/clavulanic acid, cefoperazone/sulbactam, cefotaxime/sulbactam, ceftriaxone/sulbactam, ceftriaxone/tazobactam, cefuroxime axetil/clavulanic acid, and ofloxacin/imidazole.
Antimicrobial resistance poses a global health threat, as it occurs when bacteria, viruses, fungi, and parasites evolve over time and no longer respond to medicines. This makes infections harder to treat and increases the risk of disease spread, severe illness, and death. The WHO has warned that as a result, medicines become ineffective, and infections persist in the body, heightening the risk of spreading to others.
While the overuse of antibiotics in human medicine contributes to antibiotic resistance, the widespread use of antibiotics in agriculture, especially in livestock and poultry production, is also a potential driver.
Narayan Dhakal emphasized that this decision aligns with WHO recommendations and the advice of Nepal’s own drug advisory committee. In 2021, the WHO published a list of non-recommended antibiotics based on research in its member countries to discourage their use.
One contributing factor to antibiotic misuse in Nepal is that antibiotics, despite being prescription drugs, are readily available over the counter. Many individuals purchase antibiotics without providing specific details about their health issues, and pharmacists often fail to inquire or stress the importance of completing the full course of medicine. Additionally, doctors frequently prescribe antibiotics based on clinical diagnoses, sometimes even before receiving laboratory test reports, despite the fact that antibiotics are ineffective against viral infections.
A study conducted by the Nepal Health Research Council revealed that approximately 85 percent of doctors in Nepal do not prescribe antibiotics by their generic names, opting instead for brand names. Nepal currently lacks a mandatory policy requiring the prescription of medicines, including antibiotics, by their generic names.
Furthermore, only 32 percent of doctors and health workers in Nepal have access to laboratories for antibiotic susceptibility testing, and among them, just 49 percent recommend such testing before prescribing antibiotics. This means that only 16 percent of doctors prescribe antibiotics based on susceptibility testing.
Public health experts have raised concerns that irrational antibiotic use could render these life-saving drugs ineffective due to high resistance rates. Antimicrobial resistance has already affected many patients in Nepal, highlighting the urgency of addressing the issue.
The Department of Drug Administration is taking measures to ensure compliance with the ban, including monitoring the recall of the banned drugs from the market by manufacturing companies. They also plan to halt the registration, renewal, and import approval of these medicines to prevent their use in Nepal.
