Karen Jang writes about the escalated global threat of antibiotic resistance as a result of increased antibiotic use to treat COVID-19 patients.
Antimicrobial resistance has been a public health problem and priority since before the Coronavirus pandemic. Now, at the tentative end of COVID-19’s first wave, it becomes an even greater global concern. As states and countries reopen and governments strike a balance between public health and the economy, mitigating antibiotic resistance and increasing marketing incentives for funding, new antibiotic research needs to become a bigger priority.
While many public health advisories focus on developments of treatments and vaccines of COVID-19 itself, WHO Director-General Dr Tedro Abhanom Ghebreyesus emphasized another serious escalating threat in today’s press conference: antibiotic resistance.
In his opening remarks, Dr Tedro said, “I’m glad to say a record number of countries are now monitoring and reporting on antibiotic resistance, marking a major step forward in the global fight against drug resistance. But the data they provide reveals that a worrying number of bacterial infections are increasingly resistant to the medicines we have traditionally treated them with,”
Dr Tedros’ attention to antibiotic resistance accompanies a prevalent and almost frantic use of antibiotics during the coronavirus pandemic to save patients in life-and-death situations. While antibiotics do not directly target SARS-CoV-2, the respiratory virus that causes COVID-19, they fight bacterial infections in the lungs due to the development of bacterial pneumonia in its initial stages. As bacteria evolve and accumulate mutations over time, these mutated bacteria proliferate and become resistant to preexisting antibiotics until these antibiotics are no longer potent against bacterial infections.
What studies are saying
A recently published paper in The Lancet detailed that 181 out of 191, or 95%, of hospitalized COVID-19 patients in Wuhan, China received antibiotics. Out of the 191 patients given antibiotics, 54 were non-survivors and 137 were survivors. Out of the 54 non-survivors, 53 patients, or 98%, received antibiotics and out of the 137 survivors, 128 patients, or 93%, received antibiotics. This study is evidence of the widespread use of antibiotics in treating COVID-19 patients and suggests that antibiotics play a positive role in the fight against COVID-19 bacterial infections.
Leopoldo Segal, a pulmonologist at NYU Langone Hospital, informed the group of an antibiotic called azithromycin and reported that “several of his COVID-19 patients have antibiotic-resistant infections, and nearly all are receiving azithromycin: a widely used antibiotic that kills both of the two major classes of bacteria” in ScienceMag. Due to the potency of azithromycin, this antibiotic is prescribed and used frequently by doctors to treat patients with COVID-19 related bacterial infections.
Yet, the degree of antibiotic resistance and the availability of antibiotics are not the same in all countries. The experimental and anecdotal effectiveness of azithromycin does not alleviate the risks of antibiotic resistance. In the press conference, WHO Director-General Dr Tedro stressed, “in some countries, there is an overuse of antibiotics and antimicrobial agents in most humans and animals. However, in many low and middle-income countries, these life-saving medicines are out of reach for those that need them, leading to needless suffering.” This statement demonstrates that there is a socio-economic divide of who can receive these antibiotics during this shared calamity.
Guidelines for the use of antibiotics to treat COVID-19 patients
To tackle antibiotic resistance, the WHO and public health officials are examining the two ways through which it develops: through the consumption of antibiotic-resistant plants by animals, and through the frequent use and misuse of antibiotics by humans. As a solution, one way to fix this issue would be to develop new and stronger antibiotics that would be more effective against mutating bacteria. However, WHO Director-General said, “on the supply side, there is essentially a very little market incentive to developing new antibiotics and antimicrobial agents, which has led to multiple market failures of very promising tools in the past few years, as well as finding new models to incentivize sustainable innovation, as seen with the Covid-19 solidarity trial .” With more attention and monetary funding to develop new antibiotics, researchers could synthesize new antibiotic drugs that are more potent and effective in killing antibiotic-immune bacteria, with the risk that bacterial strains will mutate again.
Meanwhile, the WHO laid out constructive guidelines for the use of antibiotics to treat COVID-19 patients for all individuals and medical professionals. Dr Ghebreyesus says, “in the current clinical management of COVID-19 interim guidance, WHO has outlined the appropriate use of antibiotic therapy for medical professionals to treat patients. Therefore, pose tackling antimicrobial resistance, while also saving lives.”