Coronavirus (769) BMJ: How covid-19 is accelerating the threat of antimicrobial resistance

23 June, 2020

Below are the citation and extracts of a feature article in The BMJ, and a comment from me.

CITATION: How covid-19 is accelerating the threat of antimicrobial resistance

BMJ 2020; 369 doi: (Published 18 May 2020)

Cite this as: BMJ 2020;369:m1983

Jeremy Hsu, freelance journalist

'The global threat of antimicrobial resistant bacteria and other superbugs is worsening as many patients admitted to hospital with covid-19 receive antibiotics to keep secondary bacterial infections in check...

The World Health Organization discourages the use of antibiotics for mild cases of covid-19 while recommending antibiotic use for severe covid-19 cases at increased risk of secondary bacterial infections and death... “WHO continues to be concerned by the inappropriate use of antibiotics, particularly among patients with mild covid-19,” Balkhy says...

“There’s a lot of uncertainty about the disease process and the pathology of the infection,” says David Hyun, senior officer of the antibiotic resistance project at the Pew Charitable Trusts in Washington, DC. “When the clinician doesn’t have all the necessary information to understand truly what’s happening in the patient, it tends to drive more antibiotic use.”...

Another risk of antibiotic misuse comes from premature hype surrounding possible therapies for covid-19. Notably, some media reports and political leaders amplified the possible use of the antibiotic azithromycin in combination with the drug hydroxychloroquine, which likely contributed to shortages of both drugs despite the lack of clinical evidence for their effectiveness...'

COMMENT: Many of us on HIFA are extremely concerned about the prospect of a post-antibiotic apocalypse: a nightmare future, driven largely by inappropriate use of antibiotics, where antibiotics are ineffective against most infections. Drug-resistant infections are already killing 2000 people a day worldwide, and could cause 10 million deaths each year by 2050. Arguably, the greatest cause of antimicrobial resistance is failure to access and apply reliable information on medicines. ‘Globally, most prescribers receive most of their prescribing information from the pharmaceutical industry [whose aim is to drive *more* use of antibiotics] and in many countries this is the only information they receive.’ World Medicines Report, WHO. In relation to COVID-19, there is a disconnect between what is recommended by WHO and what is practised on the front line. Health misinformation driven by social media adds to the toxic mix.

Best wishes, Neil

Joint Coordinator HIFA Project on Information for Prescribers and Users of Medicines

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HIFA profile: Neil Pakenham-Walsh is coordinator of the HIFA global health campaign (Healthcare Information For All - ), a global community with more than 20,000 members in 180 countries, interacting on six global forums in four languages (English, French, Spanish, Portuguese). Twitter: @hifa_org FB: