Pandemic within a pandemic: Please use antibiotics correctly

Fear of Covid-19 is driving increased over-the-counter (OTC) sales and in-hospital prescriptions of antibiotics – and fueling a silent pandemic in its wake. Globally, antibiotic use in hospitals has surged since the start of the pandemic.

Even though studies show that only eight per cent of patients admitted with Covid-19 also have an infection requiring antibiotics, more than 70 per cent receive them. In addition, many people worried about possible or actual Covid-19 symptoms have turned to buying antibiotics without seeing a healthcare worker.

This is further fueling the global crisis of antibiotic resistance, as bacteria evolve and become immune to these drugs. We must move quickly – with international policy, national laws, and local action – to control what the World Health Organization has identified as one of the 10 leading health threats to humanity.

Antibiotics treat infections caused by bacteria, and have no impact on viral diseases, such as Covid-19. Overusing them merely accelerates the emergence of antibiotic resistance, which will undercut our ability to treat common diseases.

Pneumonia or simple urinary tract infections, which can be quickly cleared by common antibiotics, may prove impossible to treat and become deadly.

This is particularly true in many African, South American and Asian countries, where access to healthcare workers is limited and there are no restrictions on antibiotic sales. In Kenya, antibiotics can be purchased without a prescription.

Drug-resistant bacteria

Bacteria that develop resistance to multiple antibiotics are responsible for causing difficult-to-treat infections, which are up to three times more likely to kill people than infections caused by non-resistant bacteria.

Data from several countries indicate that up to 50 per cent of bacteria-causing infections in critical-care units are resistant to several antibiotics. In the US, it is estimated that close to three million people get an antibiotic-resistant infection each year, leading to more than 35,000 deaths annually.

Drug-resistant bacteria are also more likely to spread from person to another, and have been known to cause large disease outbreaks in hospitals. Many Covid-19 treatment wards are grappling with this problem.

As an infectious-disease specialist working on the Covid-19 management front line and also leading the treatment of drug-resistant infections in Kenya, I have often struggled to treat patients with severe bacterial infections that had developed resistance to all available antibiotics.

Many of the recently developed drugs that could potentially treat resistant bacteria are extremely expensive. A 10-day course of one such antibiotic in Kenya, for example, costs almost $10,000, putting it beyond the reach of most patients.

OTC antibiotic purchases

In fact, many patients entering the hospital for Covid-19 treatment say that they have already taken one or more antibiotics at home in an attempt to address some of their symptoms. 

Some may argue that allowing unrestricted use of antibiotics can enable access to treatment for those unlikely to be able to see a doctor, and may be cheaper for the poor. But the resulting antibiotic resistance is expensive to treat and potentially costs lives.

What must we do to forestall this next pandemic? For starters, the WHO and other agencies must speak out strongly against the use of antibiotics in cases of Covid-19, unless these drugs are specifically indicated for another bacterial infection.
National governments must tighten restrictions on OTC antibiotic purchases.

Evidence suggests that introducing and enforcing laws to limit such sales can be effective if these efforts are sustained over time. Pharmacies should display a notice stating that it is illegal to sell antibiotics without a doctor’s prescription. Hospitals should adopt so-called antibiotic stewardship strategies to reduce unnecessary prescriptions. 

These measures can lead to reduced antibiotic use and cost, and decrease the risk of antibiotic-resistant infections in hospitals. Finally, individuals – despite their understandable fears of Covid-19 – should not risk harming themselves by using antibiotics unnecessarily.

The message is clear: If we do not act now to curb antibiotic use, we will invite a new pandemic. And, unlike Covid-19, no vaccine will save us.

Dr Ombajo is an infectious-disease specialist at the University of Nairobi and a 2021 New Voices Fellow at the Aspen Institute.