Bhutan Infectious Disease Guideliness is intended for use by medical professionals in Bhutan 🇧🇹. Information is provided as a reference guide and should not replace clinical judgement or national standards of care.
It was created by Dr. Vamini Selvanandan to facilitate quick access to treatment guidelines from the National Antibiotic Guideline 2018 published by the Ministry of Health, Bhutan.
FORWARD
Antimicrobial resistance (AMR) has emerged as a major public health issues all over the world. Though it is a global
problem, the major brunt of AMR is borne by developing countries. It is estimated that 50% or more of hospital
antimicrobial use is inappropriate and more alarming was from the developing countries, where more than 90% of
antibiotics used in surgical prophylaxis were inappropriate.
This results in treatment failure or ineffective management of infectious diseases. Antimicrobial resistance makes
the treatment of patients difficult, costly and sometimes impossible. Resistance has emerged even to newer and
more potent antimicrobial agents like carbapenems. It has been reported that almost USD 5.6 million per year per
hospital is spent because of AMR.
An important strategy in combatting the development and spread of antimicrobial resistance is optimisation of
prescribing of antimicrobials in all clinical settings, ensuring antimicrobials are prescribed and utilised according to
principles of evidence based medicine.
Therefore, rational prescription of antibiotics not only will help minimize the morbidity and mortality due to resistant
microbial infections but also curtail the cost incurred on patient management. In line with the rational prescription of
antibiotics, Essential Medicines & Technology Division, Department of Medical Services under the guidance of the
national experts from Jigme Dorji Wangchuck National Referral Hospital (JDWNRH) have come up with the 3rd Edition
of the National Antibiotic Guideline based on scientific evidence, literature review and consistent with the already
existing international guidelines as well as the local antibiogram of JDWNRH.
The treatment recommendations in this guideline for infectious diseases are grouped by organ systems and
presented in a tabular format for ease of use. Brief descriptions of disease categories with their etiologic agents,
corresponding antibiotic regimens (dose, route, frequency and duration) for adult, paediatric and neonate patients,
with relevant comments are presented. A section on surgical prophylaxis has been added since antibiotic misuse to
prevent surgical site infections also needs urgent attention.
We are confident that the guideline will rationalize the usage of antibiotics and establish consistency in the treatment
of various infectious conditions in the country.
(Dr. Pandup Tshering)
Director General
Department of Medical Services
ACKNOWLEDGEMENTS
We gratefully acknowledge the significant effort of all those who have contributed to the development and production
of this edition. In addition, the efforts of contributors to past editions are acknowledged. Contributions to this edition
(3rd) have been made by:
1. Dr. G.P. Dhakal, Gastroenterologist, JDWNRH
2. Dr. Kuenley Pedon, Paediatrician, JDWNRH
3. Dr. Kunga Penjor, Prosthodontist, JDWNRH
4. Dr. Mahesh Gurung, Cardiologist, JDWNRH
5. Dr. Pem Chuki, Clinical Pharmacologist, JDWNRH
6. Dr. Sonam Jamtsho, Gynaecologist, JDWNRH
7. Dr. Tashi Tenzin, Neurosurgeon, JDWNRH
8. Dr. Ugyen Tshering, Emergency Physician, JDWNRH
9. Dr. Ugyen Thinley, Orthopaedic Surgeon, JDWNRH
10. Dr. Yoriko Nishizawa, Neonatologist, KGUMSB
11. Mr. Raghunath Sharma, Laboratory Officer, JDWNRH
12. Mr. Thupten Tshering, Clinical Pharmacist, JDWNRH
Secretariat, layout and the cover design:
1. Ugyen Tashi, Dy. Chief Pharmacist, EMTD
For complete guidance, please refer to the complete document: National Antibiotic Guideline 2018 (PDF)