As more and more antimicrobials are used to control the virus and the co-infections, this indiscriminate use will further increase AMR
The world is struggling hard to control the COVID-19 pandemic. This is difficult as the disease is new and we do not have specific drugs and vaccines to treat it or create immunity against it. What we have in our arsenal are the existing broad-spectrum antimicrobials.
Anti-malarial drugs chloroquine and hydroxychloroquine are in great demand. It is yet not clear whether they work on COVID-19 or not. But it is well established that chloroquine is now ineffective against the malaria parasite Plasmodium falciparum, against which it was primarily used.
A combination of two HIV drugs, lopinavir and ritonavir are being experimented with too. Another top contender against coronavirus is the antiviral remdesivir which is an experimental drug developed to treat Ebola virus. This failed to treat Ebola but has been found effective against coronavirus — at least it protects more than a placebo. According to a recent study, it shortened the time needed by hospitalised adults to recover by four days and also reduced the incidence of lower respiratory tract infection. Viral infections can damage cells and make them more susceptible to bacterial infections.
Such co-infections are a primary problem in COVID-19 patients. Most of these are caused by bacterial pathogens against which, antibiotics are now more or less ineffective. This leads to high mortality. Hospital acquired infections, also notorious for being resistant, can add to the death toll for COVID-19 patients. A study of patients in China, published in The Lancet in March, showed that nearly half of the patients who died in hospitals suffered from co-infections. They died despite being treated with antibiotics. One school of thought is that they suffered from resistant infections while the other believes that the patients were to too weak to deal with the infection.
There is already a rampant misuse of antibiotics around the world and India is a leader in this. As more and more antimicrobials are used to control the virus and the co-infections, this indiscriminate use will further increase AMR — mutating rapidly to become resistant to a drug is in the inherent nature of a microbe. Ironically, though doctors and researchers have been raising the issue of antimicrobial resistance for decades now, the industry — healthcare, pharma, food animal, agriculture — has not taken any action against the global pandemic of AMR. Together with the COVID-19 pandemic, it is set to make life difficult.
Governments around the world need to make fighting AMR a top priority. It is not a difficult task — all one needs to do is to use the antimicrobials judiciously.
Down To Earth’s report Body Burden: Antibiotic Resistance has analysed the state of AMR in India and provides a roadmap to deal with the problem.
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