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COVID-19 fuelling antibiotic resistance

India has long dealt with the encroaching danger of antibiotic resistance. Has the COVID-19 pandemic exacerbated this situation? Reports indicate the answer is yes.

Antimicrobial resistance tests. Image credit: Dr Graham Beards, CC BY-SA 4.0 , via Wikimedia Commons, antibiotic resistant
Antimicrobial resistance tests. Image credit: Dr Graham Beards, CC BY-SA 4.0 <>, via Wikimedia Commons

India’s second wave of COVID-19 came at a far faster pace than the initial rise in cases in the country. As such, health systems across the country were overwhelmed – many at breaking point. According to some reports, this led to hospitals desperately using any medications at their disposal in order to halt potentially fatal secondary infections. 

Health Issues India has reported on the issue of antibiotic misuse in the past, citing a paper authored by three researchers of Gurugram-based Public Health Foundation of India (PHFI). The paper found that third- and fourth line-antibiotics — used as a last resort in cases where resistance is present to more commonly used medications — are being used indiscriminately within India.

“The third line of antibiotics is to be prescribed only at hospital-level, usually in ICUs [intensive care units]; only if the severity of the infection has reached that stage. However, to our utter surprise, we found that they are being prescribed at primary care level. This is totally unscientific and unacceptable,” said Sakthivel Selvaraj, one of the authors of the paper, in an interview with Down To Earth.

The pandemic has engendered extenuating circumstances including when it comes to the use of antibiotics. Simply as an act of desperation, Indian doctors have been using medications not used in other countries for COVID-19. While this may serve as a short-term solution where no alternatives are available, it adds fuel to the fire of antibiotic resistance. 

Secondary infections, however, have already shown to be resistant to antibiotics in many cases. One study, published in the journal Infection and Drug Resistance, analysed data from 17,534 Covid patients admitted to one of ten hospitals from June 1st to August 30th, 2020. Of these, 640 patients, or 3.6 percent, presented with a secondary infection — this figure was as high as 28 percent in some hospitals. Co-infections were caused by multidrug-resistant organisms in about half of the cases.

Critically, almost sixty percent of patients with secondary infections died, compared with about eleven percent of those who did not have a comorbid infection, according to the study. Of those who died from a secondary infection, most had underlying health concerns such as diabetes or hypertension. These preexisting conditions present the dual issue of a weaker immune system — leading to a predisposition to infection by both COVID-19 and secondary infections — as well as a heightened risk of developing more serious adverse effects following infection.

While applying a cocktail of antibiotics and medications may have worked in some instances during COVID-19, this may not be a luxury afforded for long. As the high number of antibiotic resistant secondary infections attests, these diseases are increasing in prevalence. Should another disease surge to pandemic levels, antibiotic resistant secondary infections may be all but untreatable.

The World Health Organization (WHO) has noted that pandemic preparedness should be at the forefront of global health planning. Commenting on the matter at the time, Health Issues India postured that “it is crucial to note that while COVID-19 is the pandemic on our minds right now, it is hardly implausible to think that it will be the last crisis of this magnitude. The notion of ‘the next pandemic’ is at the forefront of the minds of the agencies playing a crucial role in combating the COVID-19 outbreak.”

Many diseases such as tuberculosis (TB) have already developed resistance against many first line antibiotics. These strains are becoming ever more common, making the disease far more difficult — and expensive — to treat. Previous studies have estimated that “extensively drug-resistant TB (XDR-TB)” — strains that are resistant to almost all currently used medications — will account for 8.9 percent of TB cases by 2040, compared to just 0.9 percent in 2000. This is particularly worrying, as a high prevalence of XDR-TB will make eradication efforts almost impossible without the development of new medications.

India’s situation is dire. While the current second wave of COVID-19 may be easing, it is not unprecedented in other countries that a third wave is to be expected. Antibiotic resistance is an issue that is prevalent in India, though not isolated to the country. This is the same case for resistant strains developing anywhere in the world. Once developed, they are able to spread. As shown by COVID-19, international spread of a disease is now shockingly rapid. The next pandemic may be that of an antibiotic resistant disease that is all but untreatable.

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