75% of patients hospitalized for Covid-19 receive antibiotics, but only 6% have a bacterial coinfection that would justify their use.
A new virus, SARS-CoV-2, plunged the world into the worst pandemic of the last century, with more than 56 million infected and more than 1.3 million deaths (and counting) worldwide. But not only the appearance of new viral pathogens poses a serious danger, the misuse of antibiotics threatens to return humanity to a past in which a common bacterial infection could be life-threatening. And the coronavirus crisis sets off a new alarm in that regard. Despite being a viral disease, almost 8 out of 10 people hospitalized for Covid-19 receive antibiotics, although most do not need them.
“Hospitalized patients with Covid-19 who acquire a bacterial infection do not exceed 10%. However, 75% receive antibiotics, which increases the risk of antimicrobial resistance“said Hanan Balkhy, the deputy director general of the World Health Organization (WHO) for Antimicrobial Resistance, in a joint seminar with the World Federation of Scientific Journalists (WSFJ).
The abuse and misuse of antibiotics for years sowed the terrain of the current scenario, in which drugs that were effective for decades, They stopped working against bacteria that became resistant to them, canceling or moderating their action (Klebsiella pneumoniae y Pseudomonas aeruginosa are the ones with the greatest resistance). It is estimated that some 700,000 people die each year worldwide as a result of antimicrobial resistance and that, if no action is taken, that number will reach 10 million by 2050.
➪Can antibiotics be used to treat Covid-19? Antibiotics are not effective in treating diseases caused by viruses such as SARS-CoV-2, which causes Covid-19. (WHO)
Within the framework of the “Week for the Responsible Use of Antimicrobials”, the WHO renews its call to become more aware of this problem and to restrict the use of antibiotics only in cases of precise medical indication, a message that is addressed not only to the general population but also to health authorities, pharmacists and pharmacy dispensers and the medical community itself.
“It is estimated that by 2030 the global consumption of antimicrobials will increase by 67% and by 2050 antimicrobial resistance will be one of the leading causes of death, beating cancer. Antimicrobial resistance advances faster than the generation of new antibiotics, “said infectologist Wanda Wanda Cornistein, coordinator of the Antimicrobial Resistance Program of the Argentine Society of Infectology (SADI) and head of Infection Control at the Austral University Hospital.
In that sense, the coronavirus pandemic exhibits two related problems, according to the doctor. “Although we are in the presence of a viral disease, there was an increase in the consumption of antibiotics due to two factors. The first, associated with the habitual indication of antibiotics against pneumonia in the community, when in reality the co-infection ‘bacteria-virus’ in a pandemic it is less than 6% of cases, so there is a antibiotic overprescription. The second factor is that patients who are hospitalized and who are seriously ill due to Covid-19, suffer infections associated with health care when ventilated, with catheters or urinary catheters, and these infections are those that are mainly related to multi-resistant germs ; they are hospital infections that require a high consumption of broad-spectrum antibiotics, “he said.
“At first when you received a patient you did not know if he had coronavirus or bacterial pneumonia, so when in doubt, particularly in seriously ill patients, antibiotics were given until the results were obtained. Now we have recommendations from SADI that tell us to be cautious, recalling the infrequent coexistence of bacteria and viruses, and that if an antibiotic treatment must be done it should be for shorter periods, and in not so serious patients perhaps refrain from giving them when covid is suspected in light of radiography or laboratory data. It is necessary to leave the antibiotic only for cases of suspected coexistence of the SARS-CoV-2 virus, with a bacterial infection, “said infectologist Lautaro De Vedia, former president of SADI and head of the Special Assistance Division of Hospital Muñiz.
➪Can antibiotics be given to Covid patients? If Covid-19 patients develop bacterial infections, qualified healthcare professionals can prescribe antibiotics to treat them. (WHO)
According to Francisco Nacinovich, a member of the SADI Antimicrobial Resistance Program and head of Infectology at the Cardiovascular Institute of Buenos Aires (ICBA), the resistance mechanism needs very little stimulus to trigger and has nothing to do with the amount or duration of an antibiotic treatment.
“A single tablet of any antibiotic Poorly prescribed, especially for respiratory viral infections, is enough for the microorganism to develop the mechanisms to be resistant to that antibiotic. Antimicrobials when properly indicated in a documented infection, with culture and clinical data, eradicate the germ and resolve the disease without major consequences. Now, if antibiotics are given for a viral infection, which is where it is most used by mistake (for bronchitis, for pharyngitis, which in 80-90% of cases are caused by viruses), the bacteria that live with us habitually feel attacked and react by becoming resistant“, he indicated.
➪It is necessary to have an accurate diagnosis based on laboratory tests to distinguish between bacterial or viral infections (such as Covid-19) before starting any treatment. (WHO)
“The misuse of antimicrobials goes even beyond the specific situation of the pandemic and represents a problem with multiple responsibilities. This issue it’s up to all of usWe doctors have a lot of responsibility. Today it is known that treatments, even being shorter, are just as effective as those we did before, which were prolonged; antibiotics should be prescribed only when strictly necessary. For its part, the population has to know that the antibiotic only has to be prescribed by the doctor or dentist and that pharmacists also play an important role, they should not sell antibiotics without a prescription, in turn the authorities and governments should also control”.
“Many times we are faced with the patient’s demand for the prescription of antibiotics, when it should be the opposite: the doctor should explain the reason why he indicates the antibiotic, that should be an exceptional practice“, explained Cornistein. And he highlighted that antibiotics, like any drug, can cause adverse events.
“An infection by a multidrug-resistant bacteria can have a mortality greater than 40-60%. We are in a scenario where we have bacteria for which we do not have antibiotics to fight them. This is already happening, it is a reality in Argentina and it is very serious; and we don’t have much time to solve this problem, “concluded Nacinovich.