India must clamp down on rampant and unauthorised consumption of antibiotics to avert another potential deadly pandemic resulting from antimicrobial resistance.
Misuse of antibiotics without confirming bacterial infection will not only weaken the fight against Covid-19, but could also trigger the next pandemic, warns Satish Ranjan, molecular immunologist based in Germany.
Hospital-acquired infections
An ICMR study carried out during June-August 2020, showed that many Covid-19 patients had developed secondary bacterial or fungal infections during hospitalisation. Almost 56 per cent of them had died due to these secondary infections, says Dr Ranjan.
The study also found that most of these secondary infections were of nosocomial origin (acquired during hospitalisation) and that, too, with highly drug-resistant pathogens. This goes to highlight the poor infection control practices in India and irrational antibiotic prescription practices.
Stop excessive use
Over-the-counter sales without medical prescription must be stopped now, and excessive use discontinued in hospitals, Dr Ranjan said.
One of the most commonly consumed drugs as part of self-treatment also happens to be antibiotics available over-the-counter. Even doctors rampantly prescribe antibiotics without confirming the bacterial infection, often leading to wrong or over treatment.
India is the world’s largest consumer of antibiotics. So, it raises a great concern about their misuse by either self or upon irrational medical prescription. “Here, 75 per cent healthcare is handled by the private sector, which also accounts for 90 per cent of antibiotics consumed,” said Dr Ranjan.
Azithromycin-HCQ combo
Consumption of Azithromycin and other drugs such as HCQ has shot up among adults in 2020 compared to 2019. A study done by Washington University has revealed that consumption of antibiotics of non-child-appropriate formulation (non-CAF) jumped from 72.5 per cent to 76.8 per cent.
During the peak of the pandemic in June-September 2020, consumption was estimated at 216.4 million excess doses of non-CAF antibiotics and 38 million excess doses of Azithromycin - which is equivalent to 6.2 million Azithromycin treatment courses.
Raised case fatality
A similar trend was noticed during the second wave when the country experienced a 40 per cent increase in fatality rate compared to the first wave. Fatality was higher among adults of all age groups, but more so among younger patients.
Use of antibiotics or non-relevant drugs, either by self or based on medical advice, severely compromises natural immunity, Dr Ranjan said. This could worsen a mild Covid infection to a severe one requiring hospitalisation, even resulting in death.
No role to play
Antibiotics don’t have any role to play in viral infections, says Ranjan. A study conducted in France has clearly established that use of antibiotics, especially Azithromycin, in combination with HCQ, has led to higher fatality among Covid-19 patients.
“During the second wave I interacted with a huge number of infected people and have observed that disease severity was high among people who took antibiotics and other non-relevant drugs, as against those who desisted from such practices,” Ranjan said.
Low fatality in Germany
Instructively, Germany has experienced four waves of the pandemic so far, and the current wave is the worst. But then, the fatality rate is comparably low. The current wave is largely driven by the Delta variant, responsible for the deadly second wave in India.
There could be many factors for the lower death rate in Germany. What appears to stand out is that there is no over-the-counter sale of antibiotics or other scheduled drugs. Secondly, doctors do not prescribe antibiotics without confirming a secondary bacterial infection.
Similar instances are available from advanced countries such as the UK, the US and Canada, where the use of antibiotics plunged during the peak of Covid-19.