COVID 19 management is changing rapidly. When the disease was new, hit and trial was the mode of treatment. They treated on basis of their experience with similar respiratory illness-causing viruses. Drugs thought to be helpful initially were found to be minimally used now e.g Lopinavir, Oseltamavir, Hydroxychloroquine, Favipiravir, Remdesivir, Interferon1b, Convalescent plasma therapy etc.
Today we have some knowledge regarding the disease process and also national guidelines for the management of COVID 19 illness.
Still, It's not uncommon for healthcare professional to give personalized treatment without any rationale.
Today I am writing on antibiotic misuse in the time of the COVID 19 era.
It won't be incorrect to say that majority of us are prescribing some antibiotic for COVID 19 management which actually doesn't hold any scientific basis. World health organization have clearly mentioned no role of antibiotic in the treatment of COVID 19 until there has been any evidence of secondary infection.
What could be the supposed reason; for a doctor prescribing antibiotics in Covid 19 management :
1. To prevent secondary infection
2. A placebo effect
3. As prophylaxis because they are giving glucocorticoids
4. They think antibiotic might work on the virus as well.
5. Few antibiotics are known for their immunomodulating property e.g Doxycycline, minocycline etc.
6. In the critical care setup they give broad-spectrum antibiotic - the reason??
They have a protocol of giving antibiotics or used along with high doses of glucocorticoids. After a course of some antibiotic, they will switch to some higher antibiotic of different mechanism of action. The reason could be - TLC is high, differential shows neutrophilia. ( Isn't it can be just a reaction to glucocorticoids that cause neutrophilia or isn't it can be just an inflammatory response) or they have not got an appropriate response i.e CRP has not come down or the patient has not improved or some irrational other reason (Isn't high CRP is also can be because of the cytokine storm secondary to COVID-19; hence the context of use should be justified and rational).
There might be multiple other reasons a health care professional have in their mind for prescribing antibiotic.
Am concerned and writing today because it's not only about Covid 19 disease management; antibiotic abuse or irrational use of antibiotic is been prescribed for various other uncalled conditions as well; hence the end result would be an invitation to antibiotic resistance ???
Now the question in your mind will be -
What is an antibiotic? How does the antibiotic act? What is the major concern with this irrational antibiotic usage?
Antibiotics are the medication that fights against bacterial infection. It can kill bacteria i.e bactericidal or it can retard progression i.e bacteriostatic. It acts via various mechanism to fight with bacteria i.e inhibiting cell membrane synthesis of bacteria (e.g. Penicillins) or inhibiting protein synthesis (e.g Tetracyclines) etc. Although there are various groups of antibiotic which act via different mechanism; but still their number is much more limited if we will compare it with actual pathogenic bacteria.
How does it bother us?
The story is simple - bacteria also believes in the survival of the best theory. They are also very clever, they develop or they inherit certain evading mechanism to combat these antimicrobials. This leads to antibiotic resistance.
World health organizations say antibiotic resistance is one of the biggest threats to global health, food security, and development today. Antibiotic resistance leads to higher medical costs, prolonged hospital stays, and increased mortality.
Causes of development of antibiotic resistance
It can develop naturally via random genetic mutation or obtaining resistance gene from others or inherit resistance genes. The natural process we cant revert back or sometimes we can modify by following better hygienic measures and prevent ourselves from the pathogenic bacteria.
Using antibiotics frequently or using them for an inappropriate period of time can also lead to antibiotic resistance.
Ways to spread antibiotic resistance -
You will be thinking what if they evade we can use another antibiotic, many times changing antibiotic with a different mechanism can be effective, but not always (Superbugs).
Are superbugs rare?
NO, It's quite common. Over time this resistant bacteria spreads and becomes common pathogenic bacteria making disease resistant to the bacteria.
For example, fluoroquinolones becoming ineffective in salmonella infections, drug-resistant tuberculosis etc.
How much time does it take - a decade? Or It might affect the next generation? Do we need to worry??
Antibiotic resistance is becoming common and a big upcoming threat to humankind. There will be a situation shortly that a simple infection can be disastrous or fatal.
Now your question will be scientist, medical research should come up with new therapeutics to tackle it. Unfortunately, new antibiotic discovery over the last few years has decreased.
What is the answer to this irrational use?
World health organization says the world urgently needs to change the way it prescribes and uses antibiotics.
One of the answers to this is Antibiotic stewardship!
Antibiotic stewardship is the effort to measure and improve how antibiotics are prescribed by clinicians and used by patients. It aims to protect patients from harms caused by unnecessary antibiotic use, and combat antibiotic resistance.
World health organization says the following steps can be taken at all levels of society to reduce the impact and limit the spread of resistance.
Individuals level:-
1. Only use antibiotics when prescribed by a certified health professional.
2. Never demand antibiotics if your health worker says you don’t need them.
3. Always follow your health worker’s advice when using antibiotics.
4. Never share or use leftover antibiotics.
5. Prevent infections by regularly washing hands, preparing food hygienically, avoiding close contact with sick people, practising safer sex, and keeping vaccinations up to date.
Health professionals level :
1. Only prescribe and dispense antibiotics when they are needed, according to current guidelines.
2. Report antibiotic-resistant infections to surveillance teams.
3. Talk to your patients about how to take antibiotics correctly, antibiotic resistance and the dangers of misuse.
4. Talk to your patients about preventing infections (for example, vaccination, hand washing, safer sex, and covering nose and mouth when sneezing).
Policymakers role :
1. Ensure a robust national action plan to tackle antibiotic resistance is in place.
2. Improve surveillance of antibiotic-resistant infections.
3. Strengthen policies, programmes, and implementation of infection prevention and control measures.
4. Regulate and promote the appropriate use and disposal of quality medicines.
5. Make information available on the impact of antibiotic resistance.
Thank you for your patient reading.
Very informative sir ❤
ReplyDeleteInformative piece.Thanks for sharing
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