New evidence from the World Health Organisation (WHO) shows the extensive overuse of antibiotics during COVID-19 pandemic worldwide, which may have exacerbated the silent spread of antimicrobial resistance (AMR).
When a patient requires antibiotics, the benefits often outweigh the risks associated with side effects or antibiotic resistance. However, when they are unnecessary, they offer no benefit while posing risks, and their use contributes to the emergence and spread of antimicrobial resistance.
What is antimicrobial resistance?
• Antimicrobials — including antibiotics, anti-virals, antifungals, and antiparasitics – are medicines used to prevent and treat infectious diseases in humans, animals and plants.
• Antimicrobial Resistance (AMR) occurs when bacteria, viruses, fungi and parasites no longer respond to antimicrobial medicines.
• As a result of drug resistance, antibiotics and other antimicrobial medicines become ineffective and infections become difficult or impossible to treat, increasing the risk of disease spread, severe illness, disability and death.
• AMR is a natural process that happens over time through genetic changes in pathogens. Its emergence and spread is accelerated by human activity, mainly the misuse and overuse of antimicrobials to treat, prevent or control infections in humans, animals and plants.
• Micro-organisms that develop antimicrobial resistance are sometimes referred to as “superbugs”.
• AMR threatens the very core of modern medicine and the sustainability of an effective, global public health response to the enduring threat from infectious diseases.
• It is estimated that bacterial AMR was directly responsible for 1.27 million global deaths in 2019 and contributed to 4.95 million deaths.
• In addition to death and disability, AMR has significant economic costs. The World Bank estimates that AMR could result in $1 trillion additional healthcare costs by 2050, and $1 trillion to $3.4 trillion Gross Domestic Product (GDP) losses per year by 2030.
• Antimicrobial resistance is a drain on the global economy with economic losses due to reduced productivity caused by sickness (of both human beings and animals) and higher costs of treatment.
• Systematic misuse and overuse of these drugs in human medicine and food production have put every nation at risk. Few replacement products are in the pipeline.
• Without harmonised and immediate action on a global scale, the world is heading towards a post-antibiotic era in which common infections could once again kill.
• To counter it needs long-term investment, such as financial and technical support for developing countries and in development of new medicines, diagnostic tools, vaccines and other interventions, and in strengthening health systems to ensure more appropriate use of and access to antimicrobial agents.
Key points of the WHO study:
• While only 8 per cent of hospitalised patients with COVID-19 had bacterial co-infections requiring antibiotics, three out of four (some 75 per cent) of patients have been treated with antibiotics ‘just in case’ they help.
• Antibiotic use ranged from 33 per cent for patients in the Western Pacific Region, to 83 per cent in the Eastern Mediterranean and the African Regions.
• Between 2020 and 2022, prescriptions decreased over time in Europe and the Americas, while they increased in Africa.
• Highest rate of antibiotic use was seen among patients with severe or critical COVID-19, with a global average of 81 per cent.
• In mild or moderate cases, there was a considerable variation across regions, with the highest use in the African Region (79 per cent).
• WHO classifies antibiotics as per AWaRe (Access, Watch, Reserve) classification, according to the risk of AMR. Concerningly, the study found that ‘Watch’ antibiotics with higher resistance potential were most frequently prescribed globally.
• These findings are based on data from the WHO Global Clinical Platform for COVID-19, a repository of standardised individual-level, anonymised clinical data from patients hospitalised with COVID-19.
• Data was collected from some 450,000 patients admitted to hospitals for COVID-19 in 65 countries over a three-year period between January 2020 to March 2023.
• Overall, antibiotic use did not improve clinical outcomes for patients with COVID-19. But rather, it might create harm for people without bacterial infection, compared to those not receiving antibiotics.
• This underscores the urgent need to improve the rational use of antibiotics to minimise unnecessary negative consequences for both patients and populations.