Carriage of antibiotic-resistant fecal bacteria in nepal reflects proximity to Kathmandu

Within Nepal, geographic, social, and economic barriers greatly limit acces s to allopathic health care. The country therefore offered the opportunity to evaluate the effect of antibiotic accessibility (as measured by allopath ic medicine consumption) on antibiotic resistance in the normal intestinal flora. The aerobic gram-negative fecal flora of 33-34 healthy adults from e ach of 3 villages with different access to health care facilities in Kathma ndu were examined for antibiotic susceptibility. The frequency of antibioti c resistance decreased significantly with increasing distance from Kathmand u and decreasing population density but did not reflect contact with health care providers or individual medicine consumption. The findings suggest th at an individual's overall exposure to antibiotics and antibiotic-resistant bacteria (resulting from close proximity to other community members and to sources of accessible allopathic health care, such as in the vicinity of K athmandu), has an equal or greater impact on an individual's carriage of an tibiotic-resistant bacteria than does direct consumption of antibiotics.