COVID-19 is a major global public health challenge. All sectors are affected by the pandemic. The potential impact of the pandemic on antibiotic resistance is one of the most concerning. Antibiotic Resistance refers to a situation in which bacteria adapts so that they are not affected by antibiotic drugs. This can occur for many reasons, including misuse of medications.
Antibiotic resistance is becoming a major killer: it is forecast to kill over 10 million people globally by 2050 if it’s not tackled.
Even before the emergence of COVID-19, global use of antibiotics had increased by over 65% (daily distribution and intake) in the last two decades. The antibiotic resistance crisis may be exacerbated by the pandemic. Hospitals around the world have been using antibiotics extensively in the COVID-19 treatment package, as they have looked for an effective treatment while dealing with the uncertainty surrounding clinical outcomes.
But COVID-19 is a viral pneumonia and antibiotics are not designed to treat viral infections. Antibiotics may be used in the treatment package to speed up the development of antibiotic resistance.
COVID-19 has had an impact on the available stock of antibiotics in hospitals and communities. Across the globe, increased use of antibiotics has been reported. A study from China showed a significant increase – up to 70% of patients received antibiotics in the early emergence of COVID-19.
Excessive use of antibiotics was already the norm in Africa. The emergence of the COVID-19 only aggravated the situation. A study on the use of antibiotics for COVID-19 management across ten African countries – Nigeria, South Africa, Ghana, Uganda, Kenya, Botswana, Ethiopia, Liberia, Zimbabwe and Rwanda – showed that antibiotics were recommended in national treatment guidelines for the COVID-19 management package.
This is a disturbing development as antibiotics are not used for viral infection. Not all patients with SARS-CoV-2 will contract bacterial co-infection.
I raised my concerns about this in a journal article earlier this year. Excessive use of antibiotics in both clinical and community settings in the effort to treat COVID-19 could fuel the antibiotic resistance crisis.
To avoid this, strong antibiotic control policies must be applied. This situation requires science communication and awareness to reach a broad audience. Proper hygiene is essential to prevent infection.
Misuse of antibiotics
Antibiotic stewardship programmes vary across the world. These differences might impact the general protocol. In this COVID-19 pandemic, antibiotic stewardship has been relaxed in hospitals that have standard policy. Some antibiotics are being grossly misused in hospitals that do not have a standard and effective policy. Antibiotics are being prescribed to COVID-19 patients regardless of whether there is bacterial infection.
Many doctors prescribe treatment with antibiotics because they believe bacterial pathogens could use the conditions created by COVID-19 to infect individuals.
Another reason is that some symptoms of COVID-19 resemble bacterial infections. Doctors tend to prescribe broad antibiotics immediately without waiting for confirmation from the laboratory.
In addition, the possibility of secondary bacterial co-infection has pushed the use of antibiotics, even when there is no evidence that some patients need them. Available data show that COVID-19 co-infection with bacteria is not as great a risk as projected. In fact, bacterial infections associated with COVID-19 are minimal, even among hospitalised COVID-19 patients.
When COVID-19 emerged, misuse of antibiotics increased, even among healthy individuals without any symptoms. Because they were unsure what to expect, some people took antibiotics as a precaution. This practice had a negative impact on the availability of antibiotics. This practice may have a long-term effect on antibiotic resistance rates.
Pseudoscience and misinformation contribute to the unnecessary use of these drugs, where people with mild or even no symptoms use antibiotics to treat a viral pneumonia.
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The use of antibiotics when they are not needed is the leading driver of resistance. Other consequences include a decrease in supply and the production of counterfeit drugs.
The use of antibiotics in the treatment package of COVID-19 should only be based on evidence of bacterial infections and appropriate antibiotics susceptibility testing. You should exercise caution as the post-antibiotic era may arrive sooner than you expected.
Strict antibiotic stewardship is necessary at all levels. There is a need for standard antibiotic guidelines in the treatment package of COVID-19.
Importantly, surveillance systems must be put in place. These systems must provide updated data about antibiotic use and resistance patterns across all regions.