Post Detail

On 7–8 August 2025, Bir Hospital hosted a two-day workshop in Bhaktapur to finalise its first locally contextualised antimicrobial treatment guideline. This milestone marks an important step in strengthening antimicrobial stewardship and ensuring more rational use of medicines within the hospital.

Why This Guideline Matters

The guideline was developed under the Technical Assistance for Clinical Engagement (TACE) programme within the Clinical Engagement Workstream for the development and implementation of the Clinical Engagement Plan (CEP) and related guidelines. Its aim is simple but vital: to make sure antimicrobial prescribing reflects local clinical realities, hospital practices, and resistance patterns from Bir Hospital’s own antibiogram.

To drive this work, the Antimicrobial Stewardship Programme (AMSP) Core Committee in consultation with and with the approval of the Governance Committee formed a multidisciplinary Technical Working Group (TWG) on 8th June 2025.Their work included reviewing current prescribing practices, analysing local microbiology data, and identifying areas where contextualisation was required. Over a series of five meetings, the TWG reviewed draft sections of the guideline, addressed discipline-specific concerns, and integrated feedback into successive versions. The result was a zero draft that formed the basis of the workshop discussions.

The Workshop

Following the completion of the TWG meetings and the development of the first draft of the guidelines, the AMSP Core Committee at Bir Hospital, with technical support from Anweshan, organised a two-day workshop dedicated to the finalisation of the antimicrobial treatment guidelines.

The workshop brought together internal experts from Bir Hospital and leading external specialists in infectious diseases, microbiology, pathology, and clinical care. Chaired by Hospital Director Dr. Dilip Sharma, the sessions created a collaborative platform to refine the draft guidelines.

Opening remarks by Ms. Sangita Shrestha, Nursing Director and Member Secretary of the AMSP Core Committee, underscored the importance of collective ownership in finalising the guidelines. A plenary session followed, in which Mr. Manish Gautam, Chairperson of Anweshan, presented an overview of the CAPTURA II/TACE project, outlining its scope, significance, and contributions to antimicrobial stewardship. This was complemented by a presentation from Ms. Sanju Maharjan, Programme Manager at Anweshan, who shared the progress achieved under the project’s implementation, providing context for the current stage of guideline development.

Objectives

The workshop focused on:

• Developing and finalising a Bir Hospital-specific antimicrobial guideline based on local antibiogram data and patient care needs.
• Reviewing prescribing practices and aligning them with national and global standards.
  
  
• Promoting rational, evidence-based antimicrobial use.
• Strengthening stewardship through collaboration among doctors, pharmacists, nurses, microbiologists, and administrators.
• Incorporating locally relevant data, including resistance patterns and diagnostic capacities into practical clinical guidance.​
• Ensuring consensus and departmental ownership for smoother implementation.
• Enhancing awareness and capacity building on antimicrobial resistance (AMR) and stewardship through interactive discussion and training.​

• Contributing to national AMR containment efforts by establishing Bir Hospital as a model for guideline-based antimicrobial use.
  
  

Outcomes Expected

The final guideline aims to deliver:

• Finalization of Bir Hospital-Specific Antimicrobial Guideline​
• Improved rational use of antimicrobials.
• Reduction of inappropriate prescriptions.
• Stronger AMSP practices across departments.
• Greater awareness and Clinical Capacity and change in behaviour​
• Multidisciplinary Ownership and Engagement​
• Integration of local evidence into daily clinical decision-making.
  
  

A Collaborative Process

Participants were divided into four groups, each tasked with reviewing sections on disease systems ranging from respiratory and cardiovascular infections to surgical, oral, gastrointestinal, and immunocompromised patient care. On the second day of the workshop, each group presented its revised sections during a plenary session. This ensured that all proposed changes were openly discussed, endorsed, and collectively validated by the wider body of participants. Group discussions ensured that recommendations were technically sound, contextually relevant, and collectively endorsed.

By the end of the two-day process, the workshop achieved broad consensus, laying a strong foundation for implementing the guideline across Bir Hospital.

This initiative positions Bir Hospital as a model for evidence-based, locally grounded antimicrobial use—a critical contribution to Nepal’s wider fight against antimicrobial resistance.