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Self-Medication Surge During COVID: Amoxicillin Misuse and the AMR Crisis

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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:

  1. MDPI
  2. PubMed
  3. The Kashmir Monitor
  4. WHO
  5. International Journal of Pharmacies, Science, and Research
  6. India Today
  7. Times of India
  8. University of Minnesota- CIDRAP
  9. MDPI
  10. National Library of Medicine

Science

Jainism and the Insulin Debate: Navigating Religious Ethics in ModernHealthcare

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Jainism’s philosophy of non-violence creates ethical issues with regard to
pharmaceuticals such as insulin—particularly older versions that were produced from
animals. Although current recombinant insulin is now produced from genetically
engineered yeast or E. coli, there are still issues. Most Jains will avoid animal-
derived pharmaceuticals altogether, using plant-derived or vegan products instead.
These include not just animal-free insulin but also drugs that are not tested on
animals.

These issues are not unique to Jainism. Among vegetarians and vegans of multiple
religions, the ethical permissibility of employing insulin made from animals—or
created through the utilization of animal cell lines—is often contested. While insulin is
still crucial to treating diabetes, religiously and ethically driven adherents of various
faiths are often hard-pressed to reconcile its medical importance with their spiritual or
moral principles. Jainism is perhaps one illustration, but this struggle is pervasive in
many religious groups.
A qualitative research entitled “The Role of Religion, Spirituality, and Fasting in Coping with Diabetes among Indian Australians” examined how religious beliefs
affect attitudes toward medication and fasting. Indian migrants with diabetes held
conflicting opinions regarding the use of animal-derived insulin and other
medications. While some put health above dietary restrictions, others avoided
medicines containing pork, beef, or any animal-derived ingredient on religious
grounds.
Attitudes toward fasting were also diverse. Muslim participants, for instance,
managed to fast during Ramadan by adjusting their medication schedule and often
reported no adverse effects. Others, however, avoided fasting entirely, believing it
interfered with diabetes management, which requires regular meals. Some
individuals also admitted to fasting due to social pressure rather than genuine
religious conviction, revealing a complex interplay between faith, health, and
community expectations. In some instances, misconceptions or incomplete
understanding of religious doctrine affected insulin use and fasting decisions.
Participants of all faiths also spoke highly of the beneficial influence of religious
practices on diabetes care. Many attributed their vegetarian eating
habits—underpinned by religious principles—as useful in blood sugar control.
Practices such as yoga and meditation, consistent with Hindu thought, were also
presented as mechanisms for promoting self-knowledge, stress management, and
overall wellbeing.
The theory of Health Locus of Control (HLC) is key to understanding these
dynamics. HLC is an individual’s perception of who or what is in charge of their
health outcomes. Both internal HLC—personal responsibility—and external
HLC—spiritual leaders or divine will—are important in decision-making around
health. This implies that healthcare providers need to work with religious leaders to
dispel myths and promote medication compliance.

A paper entitled \”Animal-derived Medications: Cultural Considerations and Available Alternatives\” analyzed the ways in which religious and cultural beliefs
influence the acceptability of drugs. The review revealed that most patients,
particularly those with strong religious backgrounds, prefer to be notified about
animal-derived compounds in drugs and frequently choose alternatives, even at an
additional expense. Most physicians were not aware of these ingredients and did not
usually reveal them. Though religious leaders ordinarily allowed for exceptions
during emergencies, their interpretations diverged. The results emphasize the
necessity of physician sensitization, better labeling of ingredients, and inclusion of
spiritual history in patient treatment to promote culturally appropriate medical
practices.

Common Alternatives for the same include: Recombinant (man-made) insulins,
Vegetable-based capsules (e.g., hypromellose) and Animal-free injectables such as
fondaparinux.
Religious beliefs remain extremely influential in how individuals view and accept
insulin therapy—particularly its origin. Although recombinant insulin has countered
much of the ethical opposition, continuous communication between healthcare
providers and patients is essential. To be respectful of religious viewpoints within
medicine involves more than familiarity—it involves cultural humility rather than
mere cultural competence. This strategy advocates for more inclusive and
compassionate care through plant-based medication options, veganism, spiritual
practices, and open dialogue around religion in medicine.

Source: https://publications.aston.ac.uk/id/eprint/43238/1/Religion_and_Health_Final_Paper.pdf https://www.researchgate.net/publication/349864713_Animal- derived_medications_Cultural_considerations_and_available_alternatives

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The Frog That Took 21 Years to Speak Its Name

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Inside the long journey that led scientists to discover Leptobrachium Aryatium in Assam’s forests

In the undergrowth of Assam’s rain-soaked forests, a shy creature hopped into a scientist’s notebook in 2003. It would take 21 years before it earned its name.

This is the story of Leptobrachium aryatium — a frog species so elusive, so carefully disguised by nature, that it managed to live in plain sight for over two decades before being formally identified by Indian scientists.

Found nestled in the leaf litter of Assam’s Karbi Anglong and Dima Hasao districts, this frog was first spotted in 2003 by herpetologists conducting a survey in the Indo-Burma biodiversity hotspot — one of the richest, and most threatened, ecosystems in the world. But it didn’t quite fit the textbook description of any known species in the region. There were no dramatic colors, no telltale calls — just a set of subtle anatomical cues and a lingering question: what exactly are we looking at?

A Mystery in the Mud

Leptobrachium frogs, also known as litter frogs, are notoriously cryptic. They prefer to live under fallen leaves and remain inactive during the day, emerging quietly at night to feed and mate. The frog in question had a broad, flat head, short limbs, a stout body, and unusually large eyes for its size — all classic Leptobrachium traits. But its genetic makeup and skull structure didn’t match any of its known cousins.

“It wasn’t just about what we saw,” says Dr. Abhijit Das, a senior herpetologist at the Wildlife Institute of India and co-author of the study. “It was about what we didn’t see — this frog was an outlier. It resisted classification.”

What followed was an extraordinary example of slow, meticulous science: DNA sampling, habitat mapping, morphological comparison, and years of peer consultation — all quietly building the case for a new species.

A Name With Roots

When the research team finally published their findings in Vertebrate Zoology, they didn’t just give the frog a scientific name — they gave it a story.

Leptobrachium aryatium, they wrote, was named in honour of Arya Vidyapeeth College in Guwahati, a prestigious Assamese institution that has supported ecological research for decades. “Aryatium” roughly translates to “belonging to Arya.”

For Dr. Parag Deka, a faculty member at the college and one of the paper’s authors, the naming is personal. “It’s a way of acknowledging the generations of students and educators who believe in field biology,” he says. “This frog may not roar or dazzle, but it speaks to our shared legacy.”

A Fragile Home

The discovery also spotlights a pressing issue: habitat destruction. Much of Assam’s rich forests are under threat from logging, monoculture plantations, mining, and highway expansion. Amphibians, particularly litter frogs like L. aryatium, are deeply sensitive to microhabitat changes.

“This species is likely endemic to this specific region,” explains Dr. Das. “And that makes it vulnerable. If the forest goes, so does the frog.”

The team is now pushing for Leptobrachium aryatium to be evaluated under IUCN’s Red List and for its habitat to receive legal protection under India’s conservation framework.

Why This Matters

Globally, amphibians are vanishing faster than any other class of vertebrates. Pollution, disease, habitat loss, and climate change are decimating populations. In such a grim scenario, the discovery of L. aryatium is a reminder that our forests still hold secrets — and second chances.

“This is a victory not just for taxonomy,” says Dr. Deka. “It’s a celebration of patience, of old-school natural history, and of the power of naming something before it disappears.”

In a world obsessed with fast science and instant results, sometimes it takes 21 years to find the right words for something that was always there — quietly waiting to be seen.

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