Global medical guidelines are clear about when antibiotics should and should not be used. They can’t cure viral illnesses like the flu or common cold. Broad-spectrum antibiotics can’t be prescribed as a first-line treatment, and in most cases antibiotics shouldn’t be prescribed for long periods of time.

And yet, inappropriate prescriptions are prevalent globally. Like González, people want treatment for especially for urinary tract infections, even if there’s no microbiological confirmation of the problem.

The rise of multidrug-resistant bacterial strains of E. coli globally has reduced effective treatment options.

Bishnu Raj Karki, in Nepal, had bladder surgery after persistent UTIs in 2020. After the surgery, he got another UTI, which didn’t improve even after he took antibiotics. He crossed the border into India in hopes he’d get effective treatment. There, he was diagnosed with kidney inflammation and was prescribed a 42-day antibiotics course.

Things got worse from there. The UTI returned, and Karki had chills, a high fever, nausea and other symptoms. Now 71 years old, he still struggles to recover and requires dialysis three times a week. He’s spent more than 2 million Nepali rupees (about 14,800 dollars) on his treatment so far.

“If my UTI flares up, I know I can die at any moment,” he says.

In many cases, antibiotics are taken “like candy,” says Dr. Prabhat Adhikari, an infectious diseases and critical care specialist at the Center for American Medical Specialists in Nepal, who oversees Karki’s care.

The doctor says a prescription of a 42-day antibiotic for a UTI is bad practice and likely caused Karki to develop antibiotic resistance — the problem that ultimately caused his kidney failure.

AMR in cases of UTI are alarmingly high in Nepal, Adhikari says. A 2021 study shows that 84% of UTI cases there showed resistance to at least one antibiotic, while 54% are multidrug resistant.

“The quality of life of patients with UTI just keeps decreasing,” Adhikari says.