Healthcare providers treating COVID-19 patients have been urged to be prudent in prescribing antibiotics because of the danger of increasing resistance to the treatment.
The call was made by UKZN’s Professor Sabiha Essack, who is the South African Research Chair in Antibiotic Resistance and One Health, and collaborating scientists, Dr Ariel Blocker of France and Dr Maarten van Dongen of The Netherlands.
The three, who are part of the international Antimicrobial Resistance (AMR) Insights Ambassador Network, have expressed concern around the inappropriate use of antibiotics to treat COVID-19 patients, which can lead to antibiotic resistance.
‘The causal relationship between inappropriate antibiotic use and antibiotic resistance is well established in both hospital and community settings,’ said Essack. ‘ It is therefore essential that all healthcare providers treating COVID-19 patients, implement diagnostic stewardship/microbial diagnostics and exercise prudence in prescribing antibiotics so as not to unintentionally exacerbate antibiotic resistance.’
According to the World Health Organization (WHO) coronavirus is an infectious disease caused by the newly discovered COVID-19. ‘Most people infected with the virus will experience mild to moderate respiratory illness and recover without requiring special treatment. Those more likely to develop serious illness include the older population and those with underlying medical conditions such as cardiovascular disease, diabetes, chronic respiratory disease and cancer.’
There are no specific vaccines or treatments for the virus available yet although a variety of clinical trials are underway throughout the world. As such, healthcare providers have been using anti-retrovirals, anti-malarials and antibiotics either singly or in combination to manage COVID-19 patients. According to Essack and team, there is currently minimal robust evidence to support their use.
A study recently conducted in China, which was the epicentre of the virus, found no difference in the rate of virologic clearance at either seven days with the use of the antimalarial drug hydroxychloroquine or without it over a five-day period. They were no differences in clinical outcomes such as the duration of hospitalisation, temperature normalisation and radiological progression.
The team mention various studies undertaken across the globe which indicate the inappropriate use of antibiotics, including a single centre study of 99 COVID-19 patients in Wuhan, China, where 71% of patients were prescribed antibiotics despite elevated procalcitonin levels being recorded in only 6% of patients and bacterial co-infection in a mere 1%. Another example is of the first 12 COVID-19 patients in the United States who received empiric antibiotic treatment for possible secondary bacterial pneumonia in the absence of bacterial co-infection.
According to the WHO, ‘Antibiotics do not work against viruses, only bacteria. Since the new COVID-19 is a virus, antibiotics should not be used as means of treatment or prevention.’
Essack and team commented: ‘Such indiscriminate use in the absence of bacterial infection exerts avoidable selection pressure for the escalation of antibiotic resistance.’ The team further endorsed the four Rs of antibiotic stewardship where the right antibiotic is prescribed at the right dose and administered at the right time for the right duration so as to promote rapid recovery from infection, prevent antibiotic resistance and reduce health care costs.
Words: MaryAnn Francis