Nepali Times
Life Times


In the international medical news last week, there was a great deal of alarm caused by some resistant bacteria that infected western patients in India, who had come to the country for treatment. Such incidents could potentially threaten the medical tourism industry of India, which has been progressing by leaps and bounds Ė a jump of almost 30 per cent every year.

These resistant bacteria have been found to trigger urinary tract infections in India. Even Nepali doctors have detected such instances here that have become increasingly difficult to treat. Doctors believe that the infection here may have been introduced from India, but this remains to be investigated.

One bacterium among this resistant army is E. Coli. It appears that E. Coli has fortified itself with a special enzyme called the New Delhi metallo betalactamase (NDM), which makes it resistant to regular antibiotics such as ciprofloxacin. In fact E. Coli, doctors have found, is not only resistant to regular antibiotics, but also the Ram Banh of antibiotics Ė the extremely effective but expensive carbapenems. This is worrisome, because the antibiotic armamentarium against more dangerous strains of the usually harmless E. Coli could be fast diminishing.

India is understandably worried that the lucrative industry of medical tourism may be negatively affected by the advent of these 'superbugs'. Although the article in The Lancet Infectious Diseases that broke this story on 11 August focused on India, Pakistan and the UK, it is unclear as yet if this problem exists in other parts of the world. Only time and further studies will tell.

Regardless of how NDM plays out, it is clear that in our part of the world, there are several practices regarding antibiotic usage that may exacerbate the risks. Antibiotics in Nepal, unlike in the West, can be easily bought over the counter. This leads to misuse, and eventually resistance to antibiotics. Our future government will clearly need to have better control over the sale of antibiotics. In addition, patients need to be educated about antibiotics and their side effects. Finally, doctors need to guard against polypharmacy, which is the common practice of prescribing too many medicines or antibiotics to treat a single disease in a patient. All of these measures will help in preventing the rise of sinister enzymes such as NDM, and retain the effectiveness of treatments.

1. SA
As much as I am pleased to see the Lancet article making its way in popular Nepali media (thanks to Dr. Basnyat), I am curious to know the statistics of antibiotic resistant strains in Nepal.  As a health economist researching on antibiotic effectiveness,  I am concerned about the devastating results of over prescription and incomplete doses.

In the context of the Lancet article, one large study conducted by the International Infection Control Consortium from 2004-07 in hospitals in seven Indian cities found that, compared to CDC National Nosocomial Infections Surveillance figures from the U.S., catheter-related bloodstream infection and ventilator-associated pneumonia rates were higher in India than the U.S., whereas catheter-associated urinary tract infection rates were lower in India.  Health care Associated Infections from Streptococcus pneumoniae  and methicillin-resistant Staphylococcus aureus (MRSA) are becoming major threats in US and European hospitals.  If antibiotics resistance growths at the current rate, it is almost certain that the threat of dying from simple bacterial infections would re-emerge.

I have not come across much studies on hospital acquired infections or statistics on antibiotics use/ resistance in Nepal.  It would be great if someone could post about ongoing studies or direct to resources in that matter. 

2. ABC
I guess, this is the first time that I have ever read about irrational drug prescription. For this, we have to thanks Dr. Basnyat and NT. However, NDM issue that was raised by Indian media in response to Lancet publication has been the inciting factor for this debate. Though late, this is a burning issue and if not controlled, TIME BOMB is ticking. Any time, it may burst causing series of outbreaks of various incurable infectious diseases, the outcome of which will be incalculable. The debate on this issue must carry on wider scale and of course, as SA has pointed out that there is need for thorough scientific studies for indepth understanding of the epidemiology and economic burden.

(11 JAN 2013 - 17 JAN 2013)