Antibiotic misuse in Covid-19 gives rise to drug-resistance risk

Highlights:

• Antibiotic for bacterial infections, not for viral ones
• Antibiotic resistance to emerge as new health crisis
• Many patients take antibiotics based on social media prescriptions 

Antibiotics target bacterial infections, not viral ones such as Covid-19 – but there is still excessive use of it – though needless – in treating Covid-19 patients at hospitals.

Besides, many patients with mild or moderate infections undergoing treatment at home are also buying antibiotics over-the-counter. 

Another health crisis alongside Covid-19 is going to emerge because of such widespread misuse of antibiotics, contributing to a growing threat of drug-resistance infections, say health experts.

Physicians say antibiotics are ineffective in treating Covid-19 infections, which can only be used if there is a possibility of secondary bacterial infections. The protocol of antibiotic use is not maintained in hospitals from the upazila to tertiary level.

Professor Sayedur Rahman, vice-chairman at Bangladesh Chapter of Global Antibiotic Resistance Partnership, told The Business Standard that the level of bacterial infections among hospitalised Covid patients was 10-12%, but antibiotics were given to all patients. 

Besides, it is difficult to find people in Bangladesh who have not taken Azithromycin in the last two years. Antibiotic resistance is going to be the next health crisis, he said.

"Then, we will not be able to have surgery and treat cancer patients. Many people will die of common infections like cold and cough," Sayedur added.

Dr Tusher Mahmood, Covid researcher and medical officer at the Dhaka Medical College Hospital, told TBS that many patients coming to the hospital are resistant to all antibiotics except for one or two. 

"It is alarming. The situation of antibiotic resistance in Bangladesh will get worse in the next few years," he said.

Antibiotic resistance happens when germs like bacteria and fungi develop the ability to defeat the drugs designed to kill them.

According to a doctor's prescription obtained by TBS, an antibiotic sensitivity testing of a 77-year-old patient at a private lab in the capital showed that the patient has developed resistance to 12 antibiotics and is sensitive to only one, and is now fighting for his life.

"We know there is no role of antibiotics in the first three days of Covid-19 viral infection. Even then, in 99% cases, Covid patients with no symptoms took antibiotics," Dr Tusher said. 

Many people are taking antibiotics based on prescriptions being circulated through social media. Probably, Bangladesh is one of the two countries where antibiotics are sold over-the-counter, he added.

Covid treatment varies from person to person. But what happens in Bangladesh is when a patient recovers following a particular prescription, they suggest their acquaintances the same medicines, which worsened the misuse of antibiotics. 

A study conducted jointly by the Institute of Epidemiology, Disease Control and Research and the American Society for Microbiology found that overuse of antibiotics has increased at hospitals as well as at the individual level.

The study was conducted on patients admitted to 10 government and private hospitals in Dhaka, Chattogram, Rajshahi and Sylhet in May-July 2021 to look at the use of antibiotics in patients admitted to wards and intensive care units.

The most frequently used antibiotics are Ceftriaxone, Metronidazole, Ciprofloxacin, Flucloxacillin, Meropenem, Cefixime, Cefixime, Metronidazole, according to the study.

Ceftriaxaone, a third-generation cephalosporin, is the most commonly used drug at all public and private hospitals, excluding intensive care units. Nine out of the 10 most used antibiotics at both public and private hospitals are the same.

The top two used antibiotics at the public and private hospitals are Ceftriaxone and Metronidazole. Meropenem is the most preferred drug at intensive care units of both public and private medical colleges except Chattogram Medical College Hospital, the study said.

The use of Remdesivir at Covid-19 wards was significant. Last year, the medicine was very popular for Covid treatment. The administering of Remdesivir injection for a period of 5-10 days costs Tk50,000. The costly injection was given to 11.7% of patients at Chattogram Medical College Hospital and 22.7% at Shaheed Shamsuddin Ahmed Hospital in Sylhet.

The use of Azithromycin, Doxycycline and Amoxicillin at home has increased because of self-medication and on the advice of quacks amid the pandemic. The intake of Meropenem and Amoxiclav has increased among hospitalised patients, Professor Sayedur Rahman said. 

"As a result, we will reach the level of antibiotic resistance in a year or two instead of 3-5 years," he added.

Health experts said ensuring rational use of antibiotics by prescribers at hospitals is a great challenge in Bangladesh owing to a lack of antibiotic policy, standard treatment guidelines and antimicrobial stewardship programme.

Prof Sayedur suggested reddening the packaging of antibiotics to create awareness among the people to prevent misuse of antibiotics.

Various steps have to be taken to ensure compliance with the antibiotic guidelines. Doctors should also be aware of the need to prevent unnecessary use of antibiotics, he said.