Kathmandu, Nepal — February 15, 2026

A landmark national survey has revealed that while overall rates of drug-resistant tuberculosis (TB) in Nepal have remained stable over the last decade, a sharp rise in resistance to critical second-line antibiotics is posing a “growing concern” for the country’s latest treatment strategies.

The Sixth National Prevalence Drug-Resistant Tuberculosis Survey (2024), conducted by the National Tuberculosis Control Center with support from the WHO and other partners, found that rifampicin resistance (RR-TB) stands at 2.2% among new patients and 10.1% among those previously treated. Researchers noted that these figures are largely consistent with data from 2011, suggesting that the country’s TB control efforts have effectively prevented a major surge in resistance.

The “Strongest” Risk Factor The study identifies a clear “danger zone” for patients: those who have undergone TB treatment in the past are 4.1 times more likely to develop rifampicin resistance compared to new patients. This underscores the critical importance of treatment adherence and early drug susceptibility testing (DST).

Additionally, the survey highlighted that patients seeking care at large caseload facilities (tertiary hospitals) had significantly higher odds (AOR: 7.3) of being diagnosed with RR-TB. Experts attribute this to these specialized centers acting as referral hubs for the most complex and difficult-to-treat cases.

A Threat to New Life-Saving Regimens Perhaps the most alarming finding is the 48.3% resistance rate to fluoroquinolones among RR-TB patients. Fluoroquinolones, such as Moxifloxacin, are a cornerstone of the BPaLM regimen, a modern, shorter, and more effective treatment course that Nepal is currently scaling up.

The report warns that the “rising resistance to moxifloxacin could compromise the efficacy and sustainability” of this preferred regimen. The study links this high resistance—seen even in new patients—to the “irrational use” of antibiotics in the general population and the widespread consumption of antimicrobials in the livestock sector.

The Road Ahead While the stable prevalence rates offer some relief, the study’s authors stress that Nepal cannot afford complacency. The report calls for an “urgent need” to expand DST services nationwide and to implement strict antimicrobial stewardship.

“Expanded access to drug susceptibility testing and strengthened antimicrobial stewardship are urgently needed to guide appropriate treatment and prevent further resistance,” the report concludes. With an estimated 3,000 cases of drug-resistant TB occurring annually in Nepal—more than 70% of which remain undetected by health authorities—the findings serve as a vital roadmap for the nation’s TB control strategy.