COVID-19 and antibiotic resistance

Depiya Thoudam
Ever since December 2019, there has not been a single day where COVID-19 related news has not made daily headlines. COVID-19 is indeed a “once in a century crisis” and has thrown a big challenge for the whole world. The pandemic is not over yet and is also not getting over anytime soon. We still need to put our armour on. Antibiotic resistance has already been a thing even before this pandemic. Now there are concerns that the pandemic further aggravates the antibiotic resistance crisis. But how COVID-19, a viral infection is related to antibiotic resistance when antibiotics are designed for treating bacterial infections and NOT FOR VIRAL INFECTION?
Looking back to the 1918 H1N1 influenza A pandemic, we would all agree that it was also a deadly pandemic that had lasted over a year and had killed over 50 million people. There is abundant data showing that the majority of the deaths caused by the 1918 pandemic were attributable to secondary bacterial pneumonias. During a viral infection (say for example COVID-19), both our innate and adaptive antibacterial host defences are impaired. This temporarily compromised immunological situation can be exploited by bacteria to cause other complications. Taking cue from this, hospitals around the world have been using antibiotics extensively in the COVID-19 treatment package.  When a patient is admitted to hospital for COVID-19 and if he/she is susceptible to having an overlying bacterial infection, then use of antibiotics within the course of COVID-19 treatment is recommended if considered required. Diagnosing potential bacterial infection during COVID-19 is quite challenging as there is a desire to minimise the exposure of COVID-19 infected patients to health care providers by avoiding diagnostic procedures as much as possible.
 This is where the linkage is established between COVID-19 pandemic and antibiotic resistance. Antibiotic resistance is the ability of bacteria or other microbes to resist the effects of an antibiotic. It is something that occurs naturally but it is being accelerated by misuse and overuse of antibiotics in humans and animals. Antibiotics kill or inhibit the growth of susceptible bacteria. During this process, if one of the bacteria could manage to neutralize or escape the effect of the antibiotic, this bacterium is more likely to become resistant to the antibiotic and thus sets off the whole chain reaction of antibiotic resistance.  This situation is often provided when we use antibiotics in an irrational manner.
So knowing when is the right time or what is the correct way of taking antibiotics is very important. Our habits of taking antibiotics without having been prescribed by a licensed health care provider because last time with similar symptoms Tomba went to pharmacy and got XYZ antibiotics and it worked well for him or Chaoba’s cough did not last long because he took that XYZ antibiotics from the Pharmacy etc. etc., need to be stopped immediately. We should never take antibiotics that are prescribed for someone else even if we share the symptoms. The fact that antibiotics are for bacterial infection and NOT FOR VIRAL INFECTION needs to be very clear in our minds. So, it is always good to take antibiotics after consulting well with a doctor.
Taking the correct dose with the right duration is also important for the antibiotic to work effectively as well as to control antibiotic resistance. When given an antibiotic prescription, completing the course is a must. Even if we get better in between, the course is to be continued until its completion. Because if we don’t complete it, then we are allowing the bacteria to become more and more resistant making them less and less responsive to antibiotic treatment. Antibiotic resistance is becoming a major killer, causing significant danger to children and adults with common infections that were once easily treatable with first line antibiotics. We can minimise our antibiotic usage or  any other medicines as such by keeping ourselves need and clean; washing our hands regularly; preparing our foods in hygienic manner; maintaining proper distance from infected people; taking vaccinations in time and when required; practicing safe sex etc. Ironically, when there are concerns of antibiotic resistance due to antibiotics misuse and overuse, there are still places in the world where people are dying due to lack of access to antibiotics. Antibiotics are designed for saving lives and access to antibiotics needs to be provided.
Lack of antibiotics kills more people than antibiotic resistance. So, it is necessary that access to antibiotics is provided without compromising the measures undertaken to check antibiotic resistance. This is where the role of policy makers of a nation comes into the picture of combating antibiotic resistance. They should come out with well-crafted policies and legislations with robust action plan where good regulation system is in place for the appropriate use and disposal of antibiotics; strict surveillance for bacterial resistance infection and regular programmes that give awareness to people about the impact of antibiotic resistance and how our foolish act of misusing or overusing antibiotic can lead to antibiotic resistance. India came out with the National Action Plan (NAP) for antimicrobial resistance in 2017 whereby it identifies antimicrobial resistance as a problem and calls for effective action to address it. However, the implementation of this action plan has been slow.
This is really a matter of concern and all the more with this COVID-19 pandemic, the situation is getting worse. So we need to take it very seriously or else the post antibiotic era where infections can no longer be treated with first line antibiotics; more and more expensive medicines treatment must be used increasing our health expenditure many time folds; organ transplantations, chemotherapy and surgeries becoming more and more dangerous due to lack of effective antibiotics etc. could arrive earlier than expected.