Alexander Fleming’s prediction has come true. The inventor of penicillin—a miracle drug that easily combats infections—in his Nobel lecture in 1945, feared that “the ignorant man may easily underdose himself and by exposing his microbes to non-lethal quantities of the drug make them resistant.” His fear was primarily based on the fact that penicillin, like many other drugs, would be bought over the counter and that its arbitrary consumption would boost bacterial resistance.

Seventy years later, Fleming’s divination holds true for Nepal and many other countries in the world. A recent 10-year comparison of the drug resistance of existing antibiotics by Kathmandu Medical College in Kathmandu has painted an alarming picture. The comparison, for instance, in case of Klepsiella pneumoniae, a bacterium that is known to cause urinary tract infection, was found to have developed resistance to many drugs such as amoxicillin—while in 2004, amoxicillin was 50 percent effective against pneumoniae, this percentage had gone down to zero in 2014. Similarly in the case of Escherichia coli a bacterium that commonly causes diarrhoea, the use of amoxicillin was 50 percent effective against the bacterium in 2004, whereas in 2014, its effectiveness was under 10 percent.

These examples portray a grim picture of the role of antibiotics in fighting infections. The main concern with antibiotic resistance is the fact that minor infections have become incurable due to the resistance developed by bacterial strands. Last year, the World Health Organisation (WHO) published a comprehensive report on the situation of antimicrobial resistance, titled Antimicrobial Resistance: Global Report on Surveillance 2014. The report warns that recent trends in antibiotic resistance may be leading us to a post-antibiotic era in which common infections and minor injuries can also be fatal.

Clinical pharmacologist Dr Kumud Kumar Kafle says that the ability of bacteria to develop rapid resistance against very few available antibiotic drugs remains a major challenge of our time. According to the WHO, only three major types of antiobiotics have been developed since the discovery of penicillin in the 1920s.

Dr Kafle believes that the growing misuse and arbitrary use of antibiotics are the main reasons that this miracle drug has lost its effectiveness. Taking incomplete doses of antibiotics or overusing the drugs lead to resistance in bacteria and such prolonged practice could eventually render existing drugs completely ineffective in curing bacterial diseases.

One of the reasons for the growth in resistance by the bacteria is that patients do not follow the prescribed course for taking their medications. Such laissez faire attitudes can be attributed to both pharmacies and patients. Nepal’s Drugs Act 1978 states that antibiotics should be sold only through a doctor’s prescription; however, antibiotics are freely prescribed by many health professionals in the country, regardless of the diagnosis, and the drugs are readily available to buy over the counter in many pharmacies. Not only this, but the use of antibiotics in animal husbandry also contributes to the development of resistance when the meat products from such syntheses are consumed.

Last year, Bikash Verma (name changed), 26, of Kapilvastu, visited a nearby health post following persistent fever and cough. Upon getting there, Verma was subjected to tests that confirmed that he had tuberculosis (TB); he was immediately put on medications. However, Verma himself chose to discontinue medication after a few months into the course, thinking he was completely cured. Soon again, the symptoms resurfaced, and Verma’s indifference led to his disregarding the medications again. After a few similar episodes, he became very seriously ill. This time, the health post asked the TB centre in Bhaktapur to conduct an advanced test, and Verma was diagnosed with XDR (Extensively drug-resistant) TB, a more severe form of tuberculosis that develops as a result of a drug-resistant strain of bacteria.

Had Verma completed his first course of medicines, the costs that face him today would have been significantly low. Now, in treating this higher form of TB, he will have to spend over Rs 1,000,000. According to data published by the government, 2.6 percent of new tuberculosis cases are being diagnosed as results of infections caused by antibiotic resistant bacteria every year, while 17.9 percent of TB patients, even when they complete their course of medication, are infected with a stronger strain of the bacterium. According to the National Tuberculosis Centre, a total of 349 MDR (Multi drug-resistant) TB and 25 XDR TB patients were enrolled at the centre for treatment in 2014. Among the MDR patients, 8 percent have further developed XDR. The cost of treatment also significantly increases for patients with drug-resistant tuberculosis. For example, it costs Rs 300,000 to Rs 400,000 to treat MDR TB, and over Rs 1,000,000 for XDR-TB.

“If not properly taken care of, these patients pose a serious threat of transmitting the disease to other people,” says Dr Bikash Lamichane of the National Tuberculosis Centre.

In case of other infections, a drug that would have cost Rs 30, for instance, will cost over 300 percent more after the resistance is developed. While the possibility for treatment also narrows, the further financial burden incurred by patients also adds to their woes.   

Experts urge that the discovery of new drugs thus need to happen faster than the development of antibiotic resistance.

“Apart from this, it is essential that there be rational use of these drugs,” says Dr Kafle.