Table of Contents
- One of the greatest threats to healthcare systems, around the world, is antibiotic resistance.
- The lack of effective antibiotics and the emergence of bacteria that are resistant to the drugs we have has resulted in the antibiotic resistance crisis.
- Covid 19 can increase this crisis.
Antimicrobial resistance
- Antimicrobial resistance (AMR) is the ability of a microbe to resist the effects of medication that once could successfully treat the microbe.
- Microbes = Fungi, viruses, bacteria, protozoa
- The term antibiotic resistance is a subset of AMR, as it applies only to bacteria becoming resistant to antibiotics.
- Resistant microbes are more difficult to treat, requiring alternative medications or higher doses of antimicrobials.
- The alternative approaches may be more expensive, more toxic or both.
- MDR- Microbes resistant to multiple antimicrobials are called multidrug resistant
- XDR – extensively drug resistant
- TDR – totally drug- resistant, sometimes called ‘superbugs’
- Resistance arises through natural resistance in certain types of bacteria or by genetic mutation.
- Extended use of antimicrobials appears to encourage selection for mutations which can render antimicrobials ineffective.
- Some pathogenic bacteria have become resistant to many of the antibiotics in routine use and even to antibiotics of last resort (drugs with severe side-effects that are only used when all other antibiotics have failed).
- More than 90% of people will be prescribed an antibiotic at some point in their lives.
- But prescribing antibiotics is a finite process.
- We do not have an endless supply of antibiotics to replace those that are no longer effective, and hardly any new antibiotics are being developed.
COVID 19 and AMR
- Even though Covid-19 is a viral illness not affected by antibiotics, early data from hospitals shows that very high proportions of patients—more than 90 percent in some cohorts—are being treated with those drugs to cure or protect against secondary infections during respiratory illnesses or hospitalization.
- Very high proportions of patients hospitalized with Covid- 19 are receiving antibiotics, not to treat diagnosed bacterial infections but as insurance and protection once they are admitted to intensive care units
- A large number of people are also taking antibiotics on their own, to ‘combat COVID19’.
Historic evidence
- Pneumonia caused by a bacterial infection has historically accompanied viral pandemics.
- 1918 Spanish flu pandemic – Researches have concluded that the vast majority of the possibly 50 million deaths in 1918- 19 were caused not by influenza, but by a bacterial infection taking hold in lung tissue that had been traumatized by the flu virus.
- A study was conducted on 191 patients in two hospitals in Wuhan, China.
- The physicians found that 15 % of the patients developed secondary bacterial infections
- Half of those who were infected , died.
- Prior to the COVID-19 crisis, Italy was already the country with the highest
- number of deaths from antibiotic-resistant infections in Europe.
- 11,000 Italians died from such infections, out of 33,000 for all of Europe.
Nothing in the Pipeline
- If increases in drug resistance occur, there won’t be drugs to fix the problem.
- Antibiotic manufacturers have been abandoning the market, and some have gone bankrupt, because resistance causes their products to become less lucrative.
- Research all across the world in focussing on vaccine/curative drug for SARS COV2 – the R&D funds for new antibiotics are falling.
A second pandemic in the making
- Antibiotic Resistance was already a crisis.
- It causes an estimated 700,000 deaths around the world each year.
- COVID 19 can exacerbate it further.
- A study in 2016 estimated that by 2050, 10 million will die annually because of AMR.
- 1.2 trillion USD additional health expenditure per year expected by 2050 due to the rise of antimicrobial resistance.
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