A Second Pandemic?
Tamara Moule discusses how antibiotic resistance could be as deadly as COVID-19 to global health.
COVID-19 has created an unprecedented and worldwide health crisis this year, but scientists are now concerned that there is an even deadlier threat looming on the horizon. Antibiotic resistance is by no means a new issue but, with a rise in the prescription and use of antibiotic drugs to treat secondary infections related to COVID-19, there is a growing worry that this phenomenon could soon be harshly magnified.
Antibiotics and Antibiotic Resistance
Antibiotics work by killing bacteria or preventing their growth. Since Alexander Fleming’s 1928 discovery of penicillin, the world’s first widely used antibiotic, these drugs have revolutionised modern healthcare and saved countless lives. However, during his Nobel Prize acceptance speech in 1945, Fleming warned that the miracle of antibiotics was under threat due to bacterial resistance – a phenomenon that is being likened to a second pandemic amidst the age of coronavirus.
Resistance forms in bacteria when they are exposed to antibiotics and develop mutations that protect them against these drugs. Unfortunately, the use of antibiotics is common not only in healthcare but also in the agriculture sector, which is estimated to be the largest user of antibiotics for both treatment and stimulation of growth in livestock. This frequent use of antibiotics means bacteria likely to create resistant mutations at much faster rates.
A Second Pandemic
Frighteningly, it is estimated that some 700,000 people die due to antibiotic resistance each year and this number is set to rise. Notably, the way that COVID-19 is being treated may be one of the factors that accelerates the rates of bacteria becoming resistant.
Frighteningly, it is estimated that some 700,000 people die due to antibiotic resistance each year
COVID-19, being a viral illness, cannot be treated with antibiotics which only work on bacterial infections. However, coronavirus is known to cause secondary illnesses in patients and these infections can be bacterial. This means patients admitted to hospital care with secondary illness related to COVID-19 may be given antibiotics if their cause can’t be definitively narrowed down to being bacterial or viral. This pattern of precautionary use is dangerous in terms of bacterial resistance, increasing the exposure of bacteria to antibiotics and therefore potentially increasing rates of resistance.
Recommendations and Managing Resistance
Aware of this dangerous trend, the World Health Organisation (WHO) has published recommendations to healthcare providers on the matter. The organisation clearly advises against use of antibiotics to treat those patients that have ‘mild’ or ‘moderate’ cases of COVID-19, recommending that antibiotics are not prescribed “unless there is clinical suspicion of a bacterial infection” in the patient. Doctor Hanan Balkhy, Assistant Director-General for antimicrobial resistance at the WHO, explains that “this clear guidance on the use of antibiotics in the COVID-19 pandemic will both help countries tackle COVID-19 effectively and prevent the emergence and transmission of Antimicrobial Resistance (AMR) in the context of the pandemic.”
One data review from patients mainly in Asia found that over 70% of patients received antibiotic treatment, although under 10% actually had bacterial or fungal infections
Unnecessary use of antibiotics is certainly a factor for more rapid bacterial resistance and hence, a more measured use of antibiotics is one direct way of managing this trend. Another is the creation of new antibiotics to tackle resistant bacteria. The main pitfall of this solution is that antibiotics are only prescribed to be taken for a short period of time and must be used sparingly to prevent the spread of resistant bacteria, and as such they are a highly unprofitable drug to create. There is simply not enough market profit for pharmaceutical companies to invest in the creation of new antibiotics without government investments and incentives. Just last year two antibiotic companies in the US filed for bankruptcy despite the FDA having approved their drugs.
It is clear that we still have some way to go in terms of both managing the use of antibiotics and developing new drugs to treat infections, including secondary infections caused by newly emerging illnesses such as COVID-19. However, with its numerous economic implications research into antibiotics is simply not being conducted quickly enough – “We can’t predict when or where the next pandemic-triggering virus will emerge, but we can predict that secondary bacterial infections will follow. To fight these superbugs, we desperately need new antibiotics”, writes Julie L. Gerberding, ex-director of the Centres for Disease Control and Prevention, “An important question policymakers should be asking themselves is this: Why don’t we have powerful antibiotics on hand when we need them the most?”
With the devastating damage that COVID-19 has caused to global health so far, the crisis should act as a wake-up call to leaders worldwide to prepare for the possibility of a second pandemic – one of antibiotic resistance.