Evidence from the WHO Global Clinical Platform for COVID-19, based on anonymized data of 450,000 patients collected over three years (2020–2023), points to an alarming worldwide trend: excessive use of antibiotics throughout the COVID-19 pandemic might have rapidly spurred the insidious development of antimicrobial resistance (AMR). Although no more than 8% of COVID-19 hospitalized patients presented confirmed bacterial co-infections for antibiotic treatment, about 75% were given antibiotics—many of them as a precautionary option. This is evidence of broad over prescription throughout the pandemic.
Variation in the use of antibiotics also existed by geographical area. The rate was 33% of patients with COVID-19 treated with antibiotics in the Western Pacific Region, 83% in the African and Eastern Mediterranean regions. Remarkably, the pattern of use was decreasing in Europe and the Americas between 2020 and 2022, but it grew in Africa.
The WHO employs the AWaRe classification system—Access, Watch, and Reserve—to encourage appropriate use of antibiotics. Access antibiotics are used as first-line therapies for uncomplicated infections, Watch antibiotics have a higher risk of resistance and need to be prescribed with caution, and Reserve antibiotics are last options for severe drug-resistant infections. The study came as a concern when it was found that ‘Watch’ antibiotics—those that have a higher likelihood of promoting resistance—were most commonly prescribed during the pandemic.
Although antibiotics may be life-saving when properly prescribed, their improper use subjects the patient to unneeded side effects and promotes resistant pathogen development. After surviving COVID-19, especially among immunocompromised patients, secondary infections including bacterial pneumonia, sinusitis, and otitis media were reportedly increased. Amoxicillin is generally used for these as the first- line antibiotic.
A study titled ‘The Trend of Antibiotic Consumption After the COVID-19 Pandemic: Approach to Future Outbreaks’ examined changes in antibiotic consumption patterns. It reported a spike in antibiotic use at the onset of the pandemic in 2020 compared to 2019, driven by early fears of fatal secondary bacterial infections. Antibiotic consumption was most prevalent in the early wave of the pandemic and was strongly associated with hospital and ICU admission, particularly with broad- spectrum antibiotics. Evidence also indicated that antibiotic consumption was greater in lower- and middle-income countries compared to high-income countries.
In the United States, between January 2018 and December 2022, data from 120 hospitals indicated a rise in AMR mainly because of hospital-acquired infection rates in the pandemic period. An ICMR report in India also reported that out of 17,534 COVID-19 patients admitted to hospitals (June–August 2020), nearly half of all those with secondary infections had multidrug-resistant organisms. India saw increased self-medication with antibiotics as well during the COVID-19 pandemic. Self-medication of antibiotics in India was also aided by fear, misinformation, and the ready availability of over-the-counter medicines. As an example, in Kerala’s Ernakulam district, 18% of patients claimed to have consumed antibiotics without consulting a doctor, with amoxicillin being widely used.
Physicians have pointed to the psychological and systemic factors driving such
trends. In an interview with India Today, Senior Consultant – Internal Medicine at Delhi’s BLK Max Super Speciality Hospital Dr. Vivek Pal Singh said: “Commoners have fears, and to satisfy their psychology they pops a pill. Most doctors, I won’t say all but most doctors satisfy their patients’ fears with antibiotics. It is almost like giving them a placebo. For example, if you go to a physician and say you have a cough, rather than seeing what is causing a cough they give an antibiotic. Sometimes, I am shocked by the strength of antibiotics given by doctors inside and outside hospital settings.”
A senior resident physician at SMHS Hospital shared similar apprehensions while talking to The Kashmir Monitor said,”There is so much fear of the virus among the people that they end up taking antibiotics even for a common cold. If only they knew the extent of damage it causes rather than healing.” Azithromycin, Ofloxacin, Levofloxacin, and Amoxicillin are available over the counter and people pop them up like candies. The doctor added,“ Some of these medications like Levofloxacin delay the diagnosis of tuberculosis. Ofloxacin and Amoxicillin cause diarrhea commonly, for which the patients again take further antibiotics.” The study in the International Journal of Pharmaceutical Sciences and Research (IJPSR)reported that even medical professionals—in spite of an awareness of dangers—practiced self-medication. The Indian Council of Medical Research (ICMR) provided clear directions against the usage of antibiotics such as amoxicillin for treatment of COVID-19 unless proven bacterial infection existed. Yet studies such as from Jodhpur indicated community pharmacies still distributing antibiotics without a prescription, exacerbating the situation.
Sources:
- MDPI
- PubMed
- The Kashmir Monitor
- WHO
- International Journal of Pharmacies, Science, and Research
- India Today
- Times of India
- University of Minnesota- CIDRAP
- MDPI
- National Library of Medicine
