Antibiotics are for bacterial infections – they shouldn't be prescribed to deal with viruses. PH888/Shutterstock
Antibiotics are medication designed to deal with infections brought on by micro organism (for instance, pores and skin infections). They don’t work on infections brought on by different microbes comparable to viruses (together with COVID and flu) or fungi (for instance, thrush).
Beyond treating bacterial infections, antibiotics additionally produce other vital makes use of, like stopping an infection throughout main surgical procedure.
Bacteria have existed for billions of years and are adept at survival. Since the early twentieth century when antibiotics had been launched as medicines to struggle infections, micro organism have labored out a number of methods to guard themselves and keep away from being killed.
When antibiotics are misused or overused, extra alternatives come up for micro organism to develop and enhance these protecting instruments. This contributes to an issue referred to as antibiotic or antimicrobial resistance, the place micro organism evolve over time in order that antibiotics now not work towards them. This makes infections harder to deal with as medical doctors have fewer antibiotics to select from, in flip rising the chance of great sickness and dying.
But how has the COVID pandemic affected antibiotic use, and the issue of antibiotic resistance? A latest research which analysed pharmaceutical gross sales knowledge from 71 international locations means that as COVID circumstances went up, so did antibiotics gross sales.
The researchers examined gross sales of 4 antibiotic households generally prescribed in respiratory infections (cephalosporins, penicillins, macrolides and tetracyclines) from March 2020 to May 2022.
They sourced month-to-month gross sales knowledge for these antibiotics per 1,000 folks, and from a separate database additionally gathered knowledge on COVID infections. For comparability, the researchers used international antibiotic gross sales tendencies from 2018.
Not surprisingly, they discovered antibiotics gross sales fell sharply over April and May 2020. This drop was seemingly a results of fewer infections spreading whereas folks had been beneath strict lockdown measures, and maybe some folks avoiding healthcare.
However, antibiotic gross sales regularly elevated thereafter. The resurgence of non-COVID respiratory viral infections with the easing of lockdowns could have contributed to elevated antibiotics gross sales from 2021 onward. By May 2022, gross sales had returned to simply beneath pre-pandemic ranges.
Using statistical fashions, the researchers discovered an affiliation between rising COVID charges and better antibiotic gross sales.
Read extra:
COVID is brought on by a virus – so why are researchers treating it with antibiotics?
COVID and antibiotics
Research has beforehand recognized seasonal spikes in antibiotic use correlating with the winter virus season. This is regarding as a result of antibiotics are designed to focus on micro organism, and don’t have any impact on viruses comparable to these which trigger colds or flu.
Many antibiotic prescriptions in these circumstances are inappropriate. However, distinguishing viral from bacterial an infection might be tough clinically, particularly within the preliminary phases of an infection. This could clarify why sufferers are typically began on antibiotics whereas ready for laboratory take a look at outcomes.
In sure conditions, antibiotics are applicable. For instance, viral lung infections can harm airways and compromise the conventional protecting immune responses. This can enable micro organism to connect to airway cells and invade, inflicting a secondary bacterial an infection.
Early within the COVID pandemic, antibiotic prescribing was most likely based mostly on earlier expertise with flu, the place charges of secondary bacterial an infection had been reported to be as excessive as 65%. But because the pandemic progressed, knowledge indicated bacterial co-infection in COVID was lower than 10%. Specific antibiotic prescribing pointers for sufferers with COVID had been printed.
Yet regardless of rising proof that bacterial co-infection in COVID is low, analysis has proven antibiotic prescribing amongst COVID sufferers has remained excessive. This newest research offers additional proof that antibiotics are generally prescribed to COVID sufferers.
The research analysed pharmaceutical gross sales knowledge from 71 international locations.
SofikoS/Shutterstock
Some limitations
Similar to different giant research on antibiotic consumption, this research makes use of antibiotic gross sales knowledge as a proxy for antibiotic use. This gross sales knowledge is already captured in databases from quite a few international locations, and is extra readily accessible than knowledge on antibiotic prescriptions in lots of international locations, which is probably not captured electronically. But due to the character of the information, we are able to’t draw any conclusions as to how lots of the antibiotics bought had been appropriately prescribed.
Further, knowledge on non-COVID infections, which might influence antibiotic prescribing and charges of resistance, was not included. The pausing of routine childhood vaccination programmes throughout the pandemic most likely elevated bacterial an infection threat in some international locations, necessitating elevated antibiotic prescriptions. This could have contributed to the tendencies seen.
When deciphering these findings, it’s additionally vital to notice that not all continents had been represented equally. Some giant international locations comparable to Bangladesh had been excluded.
Finally, testing protocols differ between international locations, so there could have been some inconsistencies within the COVID case knowledge. And entry to antibiotics is inconsistent globally, particularly in low- and middle-income international locations, which seemingly impacted some international locations’ gross sales charges.
The problem of antibiotic resistance
Antibiotic resistance is a world menace to public well being, impacting people, animals and the setting.
Inappropriate antibiotic prescribing in COVID may very well be contributing to the issue. To handle this, we have to see extra alignment in pointers and protocols for clinicians, particularly linking analysis of viral respiratory infections with antibiotic prescribing pointers. Support for the event of fast diagnostics to substantiate or rule out co-infection would additionally give clinicians confidence to keep away from antibiotics in some sufferers.
Read extra:
Coronavirus pandemic is paving the best way for a rise in superbugs
More broadly, tackling the problem of antibiotic resistance requires elevated public consciousness of the problem, enhanced international surveillance of antibiotic use and resistance, improved an infection management insurance policies, and higher sanitation.
This rests on a coordinated “One Health” method – a joint international effort throughout a variety of sectors to supply options for human, animal and environmental well being. This technique ought to handle well being inequalities and would require bespoke interventions, particularly in lower- and middle-income international locations.
Deirdre Fitzgerald Hughes receives funding from Science Foundation Ireland and the Irish Research Council.
Fidelma Fitzpatrick doesn’t work for, seek the advice of, personal shares in or obtain funding from any firm or organisation that may profit from this text, and has disclosed no related affiliations past their educational appointment.
