The COVID-19 pandemic has already brought the world to its knees. Although the world is busy combating the obvious enemy, our other arch-nemesis is rising stronger than ever before during this pandemic. It is a threat with the ability to kill in greater numbers than any other human-known disease once it reaches its peak. Antibiotic resistance is this menace that we are facing.
Antibiotic resistance is a phenomenon where a germ becomes resistant to antibiotic treatment. A germ can be a virus, bacterium, fungus or parasite. Microbes can store information about antimicrobials in their genes. They use this knowledge to mutate and upgrade their defense to become stronger than the drugs used to kill them.
Injudicious use of antibiotics leads to the development of resistance in the germs when they are prescribed irrationally without proper indication of the drug. Using broad-spectrum antibiotics too frequently is yet another reason. Studies also show that almost 20-50% of all the antibiotic treatments are either inappropriately indicated or questionable.
Moreover, people often do not follow the prescription properly, stopping the medicine earlier than the prescribed period. The availability of over-the-counter antibiotics has also led to self-medication and excessive use. In either case, if a drug is taken for an inadequate period or in an inappropriate dose, it eventually results in the development of resistance.
COVID-19 is a viral disease that greatly weakens the immune system of severely affected patients, making them susceptible to secondary infections by other germs. But it is not possible to test all the patients for coinfections as manpower is already short and focused on managing the emergencies. Therefore, antibiotics are being used widely to prevent possible infections as well as for treating critical cases. Data show that less than 10% of COVID-19 patients have secondary viral or bacterial infections, whereas almost 70% of them are receiving antimicrobials as treatment or prophylaxis.
When the clinician does not have all the necessary information about the pathology of the infection, s/he inclines towards prescribing antibiotics even more. On the other hand, patients frequently demand a prescription of antibiotics in fear of the disease, thinking it would save them from greater suffering and cure them faster. Media reports about a few drugs, allegedly effective in treating COVID-19 without any reliable clinical evidence or trial, have only added fuel to this fire.
Despite the major setback in the global struggle to keep antibiotic resistance in check due to COVID-19, we must not loosen our grip on the leash. Appropriate and systematic testing of COVID-19 patients with symptoms of possible bacterial coinfections should be conducted to choose the proper treatment regimen as far as possible in the present circumstances. Antibiotics should not be consumed at any cost without professional medical advice. We can surely win over this crisis with great effort and some hope like many others we have overcome before.
The writers are researchers from the North South University Global Health Institute, Bangladesh.