Report on the GARP-Nepal meeting, December 2014 where the Nepal Situation Analysis and Recommendations (2014) was discussed by a multi-disciplinary group.
Professor Buddha Basnyat is the chair of the Global Antibiotic Resistance Partnership (GARP)-Nepal working group. The report recommends the following:
1. Reduce need for antibiotics by improving public health
Any intervention that reduces the burden of infectious disease would reduce the need for antibiotics. Clean and protected water, sanitation and uncontaminated food are obvious candidates, but these are of such broad benefit that they have strong constituencies and are not a major GARP focus, although GARP would recognize such efforts as of the utmost importance. For GARP, the most relevant focus is on vaccines. With the infant pneumococcal vaccine being added in 2016, other candidates include:
- Seasonal influenza vaccine (especially for pregnant women); and
- Typhoid (possibly during outbreaks).
2. Rationalize antibiotic use in hospitals
Infection control and prevention (IPC) measures and antibiotic stewardship are the major areas available to improve hospital antibiotic use, both including many possible interventions. Possible priorities include:
- Required functioning IPC committees
- Required use of guidelines and checklists for many purposes
- In-service training for hospital personnel in required procedures
- Improvements in laboratory facilities and procedures (e.g., implement Clinical and Laboratory Standard Institute [CLSI] guidelines
- Improve antibiotic related curriculum in all health professional education.
Accompanying all interventions must be measurement of key outcomes, including antibiotic resistance surveillance and hospital-acquired infection surveillance. The Drug Resistance Index is also in this category, as an information tool for policymakers. Nepal Situation Analysis and Recommendations 18
3. Reduce antibiotic use in agriculture
To the extent possible, the aim is to limit antibiotic use to therapeutic applications, that is, only to treat sick animals. As with people, there also are approaches to reducing the burden of disease (e.g., reduce animal crowding, improve sanitation), but the main focus is on eliminating antibiotic use for growth promotion and for disease prevention. This is an area where more information is needed before recommendations can be finalized. The initial challenge is to design an economical but informative information gathering exercise. As with human medicine, improved curriculum for professional training is needed in veterinary education.
4. Rationalize antibiotic use in the community
This is another area in which information gathering might be the first priority. It is known that antibiotics are used for many colds and mild viral illnesses, for which they are inappropriate, but that many people have too little access, whether financial or geographic, leading to childhood deaths from pneumonia and other severe bacterial infections. Improved health professions curriculum will also contribute to rationalizing community antibiotic use.
5. Ensure political commitment to meet the threat of antibiotic resistance
Establishing and maintaining clear lines of communication and establishing trust with policy makers is key to progress.