July 22, 2020: Posted by Ankit Raj
The current COVID-19 pandemic has exposed lots of fault lines in our healthcare ecosystem and magnified certain looming threats. One of them is antimicrobial resistance. Antimicrobial resistance despite of its pandemic-like nature never quite got the media coverage that it deserved. Mostly because the repercussions and threats of antimicrobial resistance veiled behind layers of scientific and medical knowledge outside the scope of understanding and imagination for most people on the planet, much like climate change. However, as a result of our continued ignorance, a world without effective antibiotics, where simpler diseases killing individuals that could have been otherwise treated by antibiotics, is highly likely. COVID-19 pandemic might have just accelerated that.
Antibiotics are aggressively being used for patients presenting with mild, moderate, and severe forms of COVID-19 illness. Hospitals and physicians are using antibiotics to keep secondary infection at bay in patients admitted to hospitals. Notwithstanding, critical patients on life-support ventilation and admitted to ICUs are being given antibiotics to treat their superimposed bacterial infections and to protect from future secondary infections. It is not only those who are admitted to hospitals or on ventilators in ICUs that are being given antibiotics. Antibiotics are being consumed aggressively, purchased over the counter, and prescribed without any evidence of a bacterial infection. Individuals with COVID-19 positive test results but without any symptoms or with just mild symptoms are also being prescribed antibiotics by their family physicians. In the absence of any specific illnesses, people have resorted to consuming antibiotics with the false hope, magnified by an ill-informed and ignorant media, that antibiotics will protect them from COVID-19.
WHO discourages the use of antibiotics as a primary modality to treat any viral illness, including COVID-19. Even the use of azithromycin, an antibiotic being used in combination with contentious hydroxychloroquine, has limited evidence in its favor. Additionally, antibiotics are not recommended as a prophylactic measure against COVID-19 illness. Many hospitals and guidelines have left it up to treating physicians to only use antibiotics in patients with high-risk factors upon their own clinical judgment.
There is an urgent need for de-escalation of the overuse of antibiotics as primary treatment and preventive modality in the current COVID-19 pandemic. Increasing clinical competence among healthcare workers and inclusion of antimicrobial stewardship into COVID-19 management guidelines are the first and essential steps to tackle this menace. Secondly, increasing testing facilities and reducing turnaround time will reduce the urge to use antibiotics. Lastly, there is an urgent need for behavior change communication and awareness campaigns among the general public towards the right knowledge and correct usage of antibiotics.
While we may come out of COVID-19 pandemic, if measures are not taken immediately, a public health emergency of antimicrobial resistance and untreatable bacterial illnesses could become a reality much sooner in the future than earlier anticipated.
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