Over-prescription has left many first-line antibiotics largely ineffective
Covid-19, an emerging pandemic, has put massive pressure on the world’s health and social care systems. One of the most significant problems that doctors and researchers face is a shortage of adequate and accessible Covid-19 treatment options. As a result, numerous antimicrobial agents are now used in hospitals and outdoors to save patients’ lives.
However, over-prescribing and the inappropriate use of antibiotics for treating Covid might contribute to the emergence of antimicrobial resistance (AMR). It could have the potential to be the next global health crisis, and has already affected the response to Covid-19.
Dr Ashraful Huq, assistant professor of the Department of Blood Transfusion, Sheikh Hasina National Institute of Burn and Plastic Surgery (SHNIBPS), said: “The post-pandemic situation in Bangladesh can deteriorate in terms of antimicrobial resistance. While working in the blood transfusion department, we have noticed that the rate of antibiotic intake among blood donors and recipients is considerably higher during this pandemic compared to before.”
He worried that people would suffer significantly after recovery from Covid-19 due to the possibility of antimicrobial resistance.
According to the national Covid-19 management guideline, irrational antibiotic prescribing is prohibited without any sign of significant secondary bacterial infection. However, irrational use of antibiotics is more common now than it has ever been. Some studies have reported that a high quantity of broad-spectrum and reserve antimicrobials are prescribed to and consumed by Covid-19 patients.
According to one study, irrational antibiotic prescription and consumption among Covid patients in Bangladesh is very common. This study included SARS-CoV-2 positive patients from a tertiary Covid-19 PCR research centre in Dhaka between July 10 and July 20, 2020.
It included 100 Covid-19 positive patients. Fever (81.0%) was the most common symptom; 45.0% of patients did not consult with physicians despite knowing their positive test results and self-medicated with antibiotics; and 36.0% were treated with multiple antibiotics and antivirals at the same time. The antibiotics most commonly used were azithromycin (46.0%), ivermectin (22.0%), doxycycline (21.0%), and moxifloxacin, which were mostly obtained from local retail pharmacies.
Dr Ashraful Huq also said that some hospitals do not strictly practise the national Covid-19 management guidelines. It includes hospitals ranging from the upazila health complex to the tertiary level, and a few specialized hospitals.
He added that lack of cooperation, inadequate research facilities, and flawed central monitoring is responsible for these issues.
We have seen that the poor knowledge of virus outbreaks, misconceptions, and social stigma about the coronavirus have created a muffled fear among general people all over the country. For this dilemma, most people are afraid of getting tested positive for coronavirus.
When they experience Covid-like symptoms, they often take self-prescribed antimicrobial drugs, and even specific trial medications from local pharmacies and quacks, without consulting doctors and disregarding their potentially adverse side effects.
A large number of people in our country do not consult a registered doctor before starting an antimicrobial course, often relying on recommendations from pharmacies. The rate of self-medication is believed to be high in Bangladesh because most medications can be purchased from local pharmacies without a prescription.
During this pandemic, social media misinformation and the availability of treatment prescriptions on various Facebook pages have also encouraged people to take antibiotics without understanding the consequences.
To summarize the current state of antibiotic resistance in Bangladesh, a systematic analysis was performed using research papers published in various journals between 2004 and 2018. 46 papers on antibiotic resistance in Bangladesh were studied. It highlights that there is a high prevalence of antibiotic resistance, leaving many first-line antibiotics largely ineffective, such as amoxicillin, amoxiclav, azithromycin, ceftriaxone, ciprofloxacin, penicillin, etc.
However, antibiotics are ineffective against Covid-19, and antibiotics only function against bacteria, not viruses. According to our guideline, antibiotic treatment or prophylaxis is not recommended for patients with mild or severe Covid-19 until signs and symptoms of a bacterial infection are present.
These drugs might have lost their effectiveness against those particular microbes due to excessive usage during the pandemic. As no new antibiotics are currently in development for potential use, the available antibiotics are losing their efficacy, which may have catastrophic effects soon.
According to the experts, several scientific studies are currently underway to determine the prevalence of antimicrobial resistance during this pandemic.
The misuse and abuse of antibiotics is a major cause of antimicrobial resistance. Increasing rates of antimicrobial resistance will leave clinicians with limited drug options to treat bacterial infections and diseases in the future. Antimicrobial resistance develops when microorganisms undergo genetic mutations. As they evolve, antibiotics may lose their efficacy over time.
Antibiotic overuse will flare up certain bacteria species, which can change their DNA to become antibiotic-resistant superbugs, and that will be a significant challenge for humanity to deal with (superbugs are strains of microbes that are resistant to most antibiotics and other medications commonly used to treat the infections they cause).
Antimicrobial resistance is a rising pandemic and challenges the effective delivery of the Sustainable Development Goals (SDGs). Prime Minister Sheikh Hasina has also warned shown concern regarding the issue.
During the opening session of the first virtual meeting of the “One Health Global Leaders Group on Antimicrobial Resistance,” she said that antimicrobial resistance would cause even more harm to global health than the coronavirus pandemic.
Additionally, as co-chair of the global leader’s group on AMR, she suggested developing guidelines and regulations to ensure adequate antimicrobial use and exchanging scientific expertise and technical assistance to ensure efficient and inclusive antimicrobial resistance monitoring and capacity-building.
Experts propose additional and comprehensive studies to determine the actual existence and rate of antimicrobial overuse in Bangladesh during Covid-19. Urgent and appropriate intervention and prevention plans should be implemented from the root level to combat the emerging threat of antimicrobial resistance during this pandemic phase.
Ashrafur Rahaman Mahadi is a medical student.