Nepal needs to rethink its antimicrobial resistance strategy

Nepal grapples with a complex antimicrobial resistance (AMR) problem, marked by stark contrasts between urban and rural access to essential medicines. In cities, antibiotics are often overused and inappropriately prescribed, even for viral infections like the common cold, as drug shops readily dispense them without a prescription. This excessive use contributes to the development of resistant bacteria.

Conversely, remote areas face the opposite challenge: limited access to basic and essential antimicrobials. This scarcity can turn treatable bacterial infections into severe, life-threatening conditions, often requiring more complicated and expensive hospital treatment by the time patients can reach medical facilities.

This tension between "access and excess" creates an "unsettling heterogeneity" in vulnerability. Addressing these contradictions requires more than just recommendations for appropriate antibiotic use. Stakeholder analysis is crucial to understand the motivations and interactions of various groups, including health systems, pharmacies, patients, farmers, and communities. Community engagement, therefore, becomes a vital tool to resolve these complex issues, needing to balance broad outreach with participatory dialogue.