A silent epidemic brews, during the pandemic

Did you know that antibiotic resistance could be the next pandemic we might have to deal with soon?

Well, the subject of antibiotic resistance being one of the biggest threats to global health and development has been discussed several times in the past. But its significance has never felt so imperative before. Given the pandemic, extensive use of antibiotics to fight secondary infections or a simultaneous bacterial infection, and significant spurt in self-medication, antibiotic resistance pattern has worsened. There is enough research that suggests our approach in treating Covid19 in hospitals could be accelerating this problem. Antibiotic resistance leads to more extended hospital stays, a higher financial burden, and an increased risk of death.

What’s more worrying is that an April 2021 WHO (World Health Organization) report revealed that none of the 43 antibiotics currently being developed “sufficiently address the problem of drug resistance” . If global Antimicrobial Resistance (AMR) goes unchecked, we will face a future where even minor infections could mean death. We may witness more than 10 million deaths due to AMR worldwide by 2050!

So, here is what we can do as patients and providers. We have already seen the rise of secondary infections and rare fungal infections such as Mucormycosis, Candidiasis, or Aspergillosis, taking a toll on patients with Covid19 during the second wave. Several studies attribute this to the injudicious use of steroids and other antibiotics. As we advance, we may see an increased incidence of drug-resistant TB and many such illnesses if we do not check on the appropriate use of antibiotics.

Self-medication

A big threat is the rise of self-medication habits among people. It is frequently noted as one of the major factors contributing to drug resistance. The WHO defines self-medication as “the selection and use of medicines by individuals to treat self-recognized illnesses or symptoms”. Moreover, lack of in-depth knowledge is another significant factor responsible for inappropriate antimicrobial use and hence the resistance.

Now, to address this issue, Fortis Hospital Mulund, Mumbai, conducted a study to understand the effect of adherence to protocols for COVID19 care and its link to a reduction in incidences of Mucormycosis. The study revealed that under strict protocol-driven use of steroids and nurse-driven tight control of glycemia, we can avoid the occurrence of Mucormycosis. The study also highlighted that the use of other immunomodulatory drugs in patients can be beneficial in preventing any secondary infections if kept very low. These kinds of initiatives are instrumental in finding ways by which we can reduce the burden of AMR. Just as a protocol-driven medication use resulted in a lower incidence of secondary infections among patients with Covid19, the same can be applied for antibiotic use. Like this, more and more healthcare providers urgently need to change the way steroids and antibiotics are prescribed and used.

Antibiotic Stewardship Programs

Antibiotic Stewardship Programs for doctors and all other healthcare practitioners can be one way to ensure appropriate use. Such programs are needed to help medical practitioners make the best clinical decisions while prescribing antibiotics. The stewardship is in the systemic effort to ensure effective treatment of infections. Through this AMRs can be controlled, as it also involves monitoring and advising on antibiotic prescriptions and use.

The other way to curb antibiotic resistance infections is when hospitals can effectively manage their waste generated. Some researchers believe that the waste could be better managed if hospitals switched to biodegradable – mainly bio-based – disposable products. These could then be sent to anaerobic digestion plants or composting facilities, creating a single, more environment-friendly waste stream.

In the end, the pandemic is demonstrating the true magnitude of the antibiotic resistance threat. It is time we take the right action. Even if new medicines develop, without behaviour change, antibiotic resistance will become the next big pandemic which will be hard to control. Behaviour changes must also include actions to reduce the spread of infections through judicious use of medicines, controlling self-medication, vaccination, hand washing, practising safer sex, and good food hygiene.

Dr Chandrashekhar is Head (Critical Care), Mumbai’s - Fortis Hiranandani Hospital and Dr Pandit is Director (Critical Care), Fortis Hospitals. Views are personal.

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