Covid-19 caused by a virus doesn’t require antibiotics for treatment. However, according to the World Health Organization (WHO), in case of hospitalization, patients may need antibiotics due to possible bacterial co-infection.
The National Centre for Disease Control (NCDC) has written to states for strictly adopting hospital infection prevention and control guidelines during the covid-19 outbreak.
“AMR can indirectly impact the outcomes of treatment in covid-19 patients. We have asked all the hospitals to adopt the guidelines while treating coronavirus patients," said a senior health ministry official.
Covid-19, in more severe cases, can cause pneumonia. Also, as per recent guidelines issued by the Indian Council of Medical Research (ICMR), antibiotic treatment should be started based on the clinical diagnosis, such as in community-acquired pneumonia, health care-associated pneumonia, or if an infection was acquired in a healthcare setting, or in case of sepsis.
“At present, SARS-CoV-2 virus is adapted for human-to-human transmission, with pathogenic consequences with almost all severe cases concluding in serious pneumonia," said Dr K. Madan Gopal, senior consultant (health), NITI Aayog, adding that patients with viral pneumonia are also at risk of developing secondary infections, and require treatment with antibiotics.
“Now, if this secondary infection is triggered by an antibiotic-resistant bacteria (ARB) then the situation becomes grave and harder to treat."
According to Gopal, by 2050, 10 million people could be losing their lives every year to AMR globally, of which one-fifth will be in India. Already, more than 50,000 newborns die in India from sepsis because of pathogen-resistance to first-line antibiotics.
The first line of antibiotics to be used in pneumonia are broad-spectrum macrolide antibiotics, such as azithromycin and clarithromycin. Public health experts have claimed that pathogen resistance for these antibiotics has been increasing in the recent past.
“In the past few years, diseases like pneumonia and typhoid have become difficult to treat, and in 70% of the cases, treatment begins with more expensive, third-generation drugs, which are administered for a longer duration than before," said Suman Kapur, senior professor, department of biological sciences, Birla Institute of Technology and Science, Hyderabad Campus.
He added that due to extensive use in humans and the poultry or livestock industry, the window of effectiveness for new anti-bacterial drugs is decreasing.
“While the problem is global, it is nowhere as stark as in India—where poor public health infrastructure, high burden of disease, and cheap, unregulated sales of antibiotics, combined with lack of awareness among patients has created ideal conditions for a rapid rise in resistant infections," said Kapur.
However, data on the contribution of AMR to mortality due to covid-19 is nascent.
Dr M. Chakravarthy, chairman, Central Infection Prevention and Control Committee, Fortis Healthcare, Bengaluru, argued that data from Wuhan in China, the epicentre of coronavirus, is worthy of analysis which reflects that antimicrobial resistance has contributed to covid-19 mortality.
“It is of extreme importance to practise the universally acclaimed preventive measures for infection control, because a bacterial infection in the midst of an overwhelming septic status caused by the coronavirus will only augur the worst," said Chakravarthy, adding that there was a shortage of antibiotics in India due to covid-19, most likely due to production cuts.