Pandemic Increased Antimicrobial Resistance

Health experts are worried about the effects the COVID-19 pandemic will have on the antimicrobial resistance (AMR) of viruses beyond SARS-CoV-2 due to the misuse and overuse of antimicrobials.

AMR occurs when viruses, bacteria, fungi and parasites adapt to the point where antivirals, antibiotics, antifungals and antiparasitics are no longer effective, making infections spread more easily and become severely more deadly.

“AMR is undermining a century of progress in medicine; infections that were previously treatable and curable with our drugs are becoming incurable,” said Joseph Thomas, Head of Antimicrobial Stewardship and Awareness, WHO, during the World Antimicrobial Awareness forum. “We must ensure that when we are sick, we are only taking antimicrobials on medical advice and medical supervision.”

The WHO described AMR as one of the top 10 health threats in the world, due to factors such as antimicrobial overuse in livestock, agriculture and humans who tend to self-diagnose. The World Bank estimates that based on current rates on AMR, by 2050 they will cause 10 million deaths annually and a 3.8 percent annual GDP reduction, affecting the world’s poorest nations and people the hardest.

During the virtual global media forum to observe World Antimicrobial Awareness Week, experts called the medical issue an “active volcano” due to the widespread use of antibiotics to treat COVID-19 patients even though it is not always appropriate. Data found that although only 7 percent of COVID-19 hospitalized patients require antimicrobials to treat a secondary infection, 90 percent of patients received them. Some drugs administered, such as Ivermectin, Azithromycin and Chloroquine, were popularly given to patients even though there is sufficient evidence proving they have no benefit in the treatment of the virus. Countries in the Americas have seen increases in drug-resistant infections as a result of this behavior according to Dr. Carissa F. Etienne, director, Pan American Health Organization (PAHO).

In Mexico, a national action strategy against AMR was established in 2018, explained José Ignacio Santos Preciado, Minister, General Health Counsel (CSG), during a CSG administered panel over the issue. This strategy will include the tracking of antimicrobial administration through the tool AwARe-CNIS to reach WHO recommended levels of consumption by 2023. Health experts in the country agreed about the urgency of this matter, since antimicrobial consumption in Mexico increased during the pandemic, especially of Azithromycin, Clarithromycin, Moxifloxacin, Ceftriaxone and Levofloxacin.

Ileana Fleitas Estévez, Consultant, WHO, explained the costly effect of AMR as patients require additional tests and the use of more costly pharmaceuticals. Fleitas also explained that AMR could increase COVID-19 related deaths as patients could develop secondary infections not responsive to antimicrobials that could complicate their treatment. Since 2019, the WHO has worked on a project alongside the Food and Agriculture Organization of the United Nations (FAO) to control AMR at a global level for agriculture and livestock.

Companies such as bioMérieux are also developing tools for syndromic diagnosis, speeding up test results and largely eliminating the need to apply antibiotics while waiting for a diagnosis. Other technology, such as automation in antibiotic susceptibility tests, is also contributing to the betterment of medical treatment in the country and lowering the medical reliance on antimicrobials. For the self-diagnose of these drugs, campaigns regarding the spread of AMR information could be highly effective in reducing rates and future risks.