Prescription of antibiotics defied Covid protocol

The critically ill patients who overwhelmed the hospitals during the first wave of Covid-19 in April last year and second wave in July-August this year exhibited the telltale symptoms of Covid-19 – high fevers and lung infection.

With few treatment options, physicians turned to their weapon of choice, prescribing from a broad spectrum of antibiotics. Now medical research shows as much as 80% of the prescribed antibiotics were unnecessary and did not follow the national coronavirus treatment protocol.

Doctors of Mugda Medical College Hospital, who carried out the research, said antibiotics amounted to 70% of medications for hospitalised patients. The use of the drugs was 80%-100% for patients at intensive care units.

Defending the medications, Prof Sayedur Rahman, vice-chairman of the Bangladesh Chapter of Global Antibiotic Resistance Partnership, argued that doctors emphasised saving as many lives as they could instead of firmly sticking to the protocol.

According to the research, 33% Covid patients took antibiotics on their own even before hospital admission.

The researchers warn of a mass antibiotic resistance, which they term another Covid-like pandemic, if the use of antibiotics is not reduced. They underscored ensuring the proper use of the drugs before a third wave of Covid rips through the country.

"More than 87% of the hospitalised patients were prescribed one to two antibiotics. But only 7% hospitalised patients required those drugs," Prof Dr Rubina Yeasmin, one of the researchers and also the head of medicine at Mugda hospital, told The Business Standard.

But the national guideline by the health ministry limits antibiotic uses only for secondary infections. According to the guideline, simple antibiotics (amoxycillin and clavulanic acid) should only be prescribed at the discretion of the consultant and if there is strong suspicion of secondary bacterial infection.

Prof Rubina Yeasmin said the doctors were trained on the Covid treatment guideline. But there had been hardly any follow up whether they maintained it.

Prof Dr Ahmedul Kabir, general secretary of Bangladesh Society of Medicine and a board member of the treatment guideline committee, agreed that doctors in most of the cases did not follow the protocol.

"Since the disease was new and we had no idea, many physicians unnecessarily prescribed antibiotics," Prof Ahmedul Kabir said.

In June last year, the World Health Organization (WHO) warned the increased use of antibiotics to combat the pandemic will strengthen bacterial resistance and ultimately lead to more deaths during the crisis and beyond.

Lab facility also to blame

During the first and second waves, doctors prescribed the drugs as soon as patients got their lungs infected as most of the hospitals do not have any lab arrangement to test bacterial infection.

Prof Rubina Yeasmin said the lab at her workstation Mugda medical – one of the major Covid dedicated treatment facilities in Dhaka – does not have bacteria culture tests. They did not have the time to refer the patients to get the test done elsewhere too.

She said the lack of testing also contributed to the over-prescription.

Where is the policy for antibiotics?

Prof Sayedur Rahman said it is difficult to find people in Bangladesh who have not taken the antibiotic Azithromycin in the past two years.

Echoing the WHO warning, he said antibiotic resistance is going to be the next health crisis since Bangladesh does not have any specific policy for the use of antibiotics.

Prof Rubina Yeasmin said the country must prepare the policy immediately and ensure monitoring so that doctors maintain it.

Besides, Prof Sayedur Rahman advocated for ramping up lab facilities for bacteria culture tests. He also stressed on raising a mass awareness campaign.

Prof Dr Ahmedul Kabir said a national-level policy for the use of antibiotics is being formulated.