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Covid and Antimicrobial Resistance: It's Time to Intervene

Antimicrobial resistance Dec 13, 2021

Antimicrobial resistance has been a threat to public health long before the arrival of the Coronavirus. Antimicrobial resistance (AMR) refers to the development of viruses, bacteria, and fungus which are resistant to commonly used antibiotics. These microbes, commonly called superbugs, cause infections that are difficult to treat and contain. AMR arises primarily owing to the nonjudicial use of antibiotics in both humans and animals. When there is a prolonged exposure to antibiotics, microorganisms eventually evolve and develop mechanisms to inhibit the action of these drugs which results in multidrug-resistant strains. Although this is a natural process, the increased use of antibiotics has put it in hyperdrive, drastically reducing the time for the development of new superbugs. The current COVID pandemic has led to the rampant use of antimicrobials all over the country further worsening this situation. The antimicrobial resistance which was already slowly growing is now on an exponential rise.

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Impact of COVID

When the COVID pandemic reached Indian shores, our health system was underprepared, to say the least. What resulted was mounting number of cases and rising mortalities. This put tremendous pressure on the already overstretched health system. Antibiotics are not effective against the COVID infection. However, they are used to treat secondary bacterial and fungal infections that COVID patients may acquire during their hospital stay. Hospital admissions have shown a dramatic surge over the past year with many hospitals overflowing with patients. The exponential rise in inpatient admissions in a resource-limited health system like India has made sticking to infection control protocol difficult. This means that these coinfections could easily spread from one patient to the next. Adding on to this problem, the use of steroids in COVID treatment impairs patients' immunities, putting them at a greater risk of such infections. Rising cases of such infections has forced doctors to administer more antibiotics further contributing to the overall antimicrobial resistance. In some cases, doctors fearing for their patients' lives resort to the indiscriminate prescription of these antibiotics even before they are diagnosed with such secondary infections. In a recent study, 70% of the included COVID patients were administered antibiotics but only 10% had any such coinfections.

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There is also a close resemblance between the symptoms of severe COVID inflammatory reaction and bacterial pneumonia. Doctors often find it difficult to distinguish between the two clinically. Laboratory investigations that can differentiate the two, often take a long time and are not available everywhere. Some of these patients also require immediate interventions. Faced with a high patient load and skyrocketing death tolls, exhausted doctors often do not wait for these results and adopt empirical treatment with broad-spectrum antibiotics. Also, since COVID largely presents with nonspecific symptoms, patients might be misdiagnosed with a bacterial infection resulting in the unnecessary use of antimicrobials.

In the early months of the pandemic, due to the lack of uniform treatment guidelines and in a desperate attempt to save lives, many physicians resorted to treatment with low efficacy drugs like chloroquine and azithromycin. There is no evidence to prove the benefits of these drugs and their increased use may lead to the development of drug-resistant strains. Although the long-term effects of COVID-19 are not well-understood, many of the survivors suffer from significant lung damage which makes them vulnerable to future infections. This may result in an increased use of antimicrobials in the coming years. Rising incidence of AMR calls for urgent measures to mitigate their nonjudicial use. If the present trend continues, it could result in a public health disaster where even common infections would become impossible to treat.

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JEFFREY MATHEW BOBY

A passionate medical student with a keen interest in oncology. He enjoys reading and is also an avid traveler and foodie who passes his leisure time exploring new cultures and cuisine.

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