COVID-19 aggravates antibiotic misuse in India

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The COVID-19 catastrophe in India has caused more than 30 million people infected with the virus and nearly 400,000 deaths, although experts worry that the numbers are likely to be much higher. Meanwhile, another public health crisis has emerged along with COVID-19: widespread use of antibiotics.

During the first wave of COVID-19 in India, sales of antibiotics increased, suggesting that the drugs were used to treat mild to moderate cases of COVID-19, according to research led by the Faculty of Medicine. University of Washington in Saint Louis. This use is considered inappropriate because antibiotics are only effective against bacterial infections, no such as COVID-19, and overuse increases the risk of drug-resistant infections.

“Antibiotic resistance is one of the greatest threats to global public health,” said the study’s lead author, infectious disease specialist Sumanth Gandra, MD, associate professor of medicine and hospital epidemiologist associated with ‘Barnes-Jewish Hospital. “Excessive use of antibiotics decreases their ability to effectively treat minor injuries and common infections such as pneumonia, which means these conditions can become serious and deadly. Bacteria that have become resistant to antibiotics have no limits. They can be spread to anyone in any country. “

The study, conducted in collaboration with McGill University in Canada, is published on July 1 PLOS medicine. Giorgia Sulis, MD, Ph.D., postdoctoral researcher at McGill, is the first author.

Antibiotics are life-saving drugs. However, without control, germs learn to challenge antibiotics designed to kill them while multiplying in strength. Along with more illnesses and deaths, entails an increase in hospital stays and medical costs

In general, in high-income countries such as the United States, the United Kingdom, and Canada submerged in 2020, even during the COVID-19 summits. “This is because doctors in high-income countries did not usually prescribe antibiotics for mild to moderate COVID-19 cases,” Gandra explained. “The increase in India indicates that the COVID-19 guidelines were not followed.”

Also of concern are previous data analyzes that conclude that COVID-19 cases and deaths in India exceed official estimates. “Actually, the problem is likely to be much worse,” said Gandra, who is also part of a World Health Organization (WHO) committee focused on reducing antibiotic prescriptions in income countries. low and medium.

With nearly 1.4 billion people, India is the second most populous country in the world. “India is essential to study as it is the largest consumer of antibiotics in the world and is basically a child fond of antibiotic abuse in low and middle income countries with similar health practices.” , explained Gandra. “In general, these countries over-prescribe antibiotics in primary care settings. Therefore, we suspect that the pandemic has also led to inappropriate use of antibiotics in many low- and middle-income countries.”

Antibiotic use increased despite guidelines from the Ministry of Health of India and the WHO urging antibiotics for mild to moderate forms of COVID-19, which account for more than 90% of cases. “Antibiotics should only be given to patients who develop secondary bacterial diseases,” Gandra said. “It was not, indicating the need for policy changes in India, especially in light of the current crisis and the possibility of a devastating third wave.”

In India, an unregulated private sector accounts for 75% of healthcare and 90% of antibiotic sales, Gandra said. “This allows for excessive prescription of antibiotics,” he said. “Low- and middle-income countries tend to skip diagnostic tests for respiratory diseases because most patients can’t afford it, so they get antibiotics on the assumption that their disease is bacterial. In the U.S., however, patients with colds or coughs are usually tested for bacterial infections such as streptococcus and only receive antibiotics if the tests are positive. “

To assess the impact of the pandemic on antibiotic use, the researchers analyzed monthly sales of all antibiotics to India’s private healthcare sector from January 2018 to December 2020. The data came from an Indian branch of IQVIA, a health information technology company based in the United States.

Specifically, the researchers examined the total sales volume of all antibiotics, as well as the individual sales volume of azithromycin. The latter was studied because some countries experienced an increase in azithromycin sales at the beginning of the pandemic after observational studies suggested that the antibiotic could help treat COVID-19 (later studies discussed the claim ).

The researchers determined that a total of 16.29 billion doses of antibiotics were sold in India in 2020, which is slightly lower than the quantities sold in 2018 and 2019. However, when the researchers focused in adult doses, use increased from 72.6% in 2018 and from 72.5% in 2019 to 76.8% in 2020.

In addition, sales of azithromycin for adults in India increased from 4% in 2018 and from 4.5% in 2019 to 5.9% in 2020. The study also showed a marked increase in sales. of doxycycline and faropenem, two antibiotics commonly used to treat respiratory infections.

The researchers used previously published studies to compare the use of antibiotics in India with the use of these drugs in the United States and other high-income countries. In these countries, researchers found that the use of antibiotics for adults decreased dramatically during the pandemic compared to that use in 2018 and 2019.

“It is critical to recognize that antibiotic use in high-income countries fell in 2020,” Gandra said. “Isolated people, closed schools and offices and fewer people had the flu and generally remained healthier compared to the years before the pandemic. This reduced the general need for antibiotics, as well as cancellation of dental procedures and outpatient surgeries “.

“India also had restrictions and experienced drastic decreases in malaria, dengue, chikungunya and others and infections that are normally treated with antibiotics,” he said. “The use of antibiotics should have decreased, but it didn’t. Not only that, but the use of antibiotics increased along with the increase in COVID cases.”

After statistically adjusting for stability and mandatory blocking periods, the researchers estimated that COVID-19 probably contributed to 216.4 million overdoses of adult antibiotics and 38 million overdoses. azithromycin for adults from June 2020 to September 2020, a maximum period of four months. COVID-19 activity in India. “Our results indicate that almost everyone who was diagnosed with COVID-19 received an antibiotic in India,” Gandra said.

Azithromycin is a vital medicine for treating typhoid fever, non-typhoid Salmonella and traveler’s diarrhea. “Unnecessary use will cause resistance among the bacteria that cause these diseases,” Gandra said. “These infections are highly common in India and other low and low level countries … and azithromycin is the only effective oral treatment option available for typhoid fever in Pakistan ”.

The researchers also studied hydroxychloroquine, an antimalarial drug that was promoted as a potential treatment for COVID-19 before the pandemic. In India, drug sales declined after the government issued an emergency order imposing stronger restrictions on the sale of hydroxychloroquine. Gandra said the Indian government should firmly consider imposing similar restrictions on azithromycin and other antibiotics.

“The latest wave in India is at least four times the first wave, and preliminary research shows a similar dependence on use to treat mild to moderate cases of COVID-19, “he said.” The medium- and long-term consequences on bacterial resistance patterns are very worrying, highlighting the need for urgent antibiotic custody measures, including mass vaccination. ”


The very high use of antibiotics in treatment with COVID-19 could be reduced


Citation: COVID-19 aggravates antibiotic abuse in India (2021, July 1) recovered on July 1, 2021 at https://medicalxpress.com/news/2021-07-covid-aggravates- antibiotic-misuse-india.html

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