- This document provides information to healthcare workers on the rational use of antibiotics for empirical or definitive treatment of commonly encountered infections in Nepal, as well as various prophylactic measures. However, it is not exhaustive and excludes infections for which national treatment protocols already exist.
- This document will be regularly updated as new data becomes available.
INTRODUCTION
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The National Antibiotic Treatment Guidelines were initially released by the Ministry of Health and Population in 2014 to align with the regional strategy of preventing and containing Antimicrobial Resistance (AMR) developed by the World Health Organization’s South-East Asia Regional Office. These guidelines aimed to address the emergence and spread of resistance, optimize the use of available antimicrobial agents, reduce selection pressure through appropriate control measures, change the behavior of prescribers and communities to ensure rational use, and combat AMR through nationally coordinated efforts.
Since the circulation of the first guideline in 2014, significant changes have occurred in Nepal’s health sector. The focus has shifted towards healthcare, and diagnostic and therapeutic services, once limited to a few cities, are now accessible in the periphery. The establishment of Intensive Care Units (ICUs) and the deployment of trained personnel to remote areas will increase the demand and use of antimicrobials. This updated version of the National Antimicrobial Treatment Guidelines aims to provide prescribers with the necessary guidance on selecting the right drug, dose, and duration for commonly encountered infectious conditions in Nepal.
The document incorporates the cumulative antibiogram from national AMR surveillance data, considers the availability and affordability of drugs in Nepal, references the National List of Essential Medicines (NLEM), and consults other national and international protocols and guidelines. Efforts have been made to prioritize antibiotics from the “Access” group (as per the WHO AWaRe Classification of antibiotics) as the first-line therapy whenever possible. It should be noted that this document adopts the WHO’s AWaRe classification.
This update introduces additional topics, such as infections of the Central Nervous System (CNS) and infections caused by multi-drug resistant organisms often associated with healthcare settings. Furthermore, the guideline provides expanded information on infections in the pediatric and neonatal populations.
The primary objective of this guideline is to promote Antimicrobial Stewardship Programmes (AMSP). However, it is essential for each institution to develop its own antimicrobial guideline based on their local antibiogram.
- To offer guidance for the optimal use of antimicrobials in various infectious conditions and for prophylactic purposes, taking into account the cumulative antibiogram from National AMR surveillance.
- To promote the preferential use of antimicrobials from the “Access” group, while ensuring judicious use of those from the “Watch” and “Reserve” groups.