Medical professionals have spent the better part of the last two years discovering ways to treat COVID-19, the disease caused by the novel coronavirus SARS-CoV-2. The treatment of a virus such as this can be challenging because, unlike a bacterial infection, antibiotics have no effect on a virus.
Various antibiotic treatments may not prevent or treat COVID-19, but they have been used frequently, both as a kind of placebo to soothe panicked nerves, and as a way to treat comorbid bacterial infections that make patient recovery even harder. The problem with the heavy use of antibiotics is that it has the potential to create an even bigger problem — one of antimicrobial resistance.
What will be necessary to prevent COVID-19 and COVID-adjacent treatments from causing antimicrobial resistance problems?
Bacterial comorbidities
COVID-19 treatment approaches have been unique over the past two years, in that medical professionals have spent a lot of time improvising, learning how to treat this novel virus without any previous experience. A study found that during the beginning of the pandemic, more than half of hospitalized COVID-19 patients were given antibiotics to treat a bacterial coinfection, with nearly all of them receiving treatment before a bacterial infection was confirmed.
A similar study found that more than 70% of patients received antibiotics or antimicrobial treatments, but less than 10% of them had confirmed bacterial or fungal infections. While there have been cases of bacterial coinfections within patients being treated for COVID-19, most patients given antibiotics were prescribed them in an abundance of caution to try and prevent coinfections from developing during treatment.
The threat of antimicrobial resistance
The invention of antibiotics changed modern medicine forever. Simple infections that were once fatal were suddenly treatable, saving lives and reducing hospital stays. While this was a valuable tool, it brought with it a hidden risk: antimicrobial resistance.
It’s not humans or animals treated with antibiotics that become resistant. Instead, it’s the bacteria themselves, taking more powerful or more frequent antibiotic applications to achieve the same results, or simply becoming completely immune to treatment.
Medical professionals have witnessed this in a number of different situations. Tuberculosis, a bacterial infection of the lungs, was frequently fatal before the introduction of antibiotics. It used to respond quickly to treatment. Now, if a patient doesn’t finish all of their prescribed antibiotics, the infection can come back stronger, now resistant to the treatment, and often fatal. A similar case has been seen with MRSA — methicillin-resistant Staphylococcus aureus — which has become endemic in hospitals and is one of the two most common health care-acquired infections.
These are only two common examples. The more that antibiotics are used, especially when there is no bacterial infection to treat, the more common these cases will become.
The research breaks antibiotic-resistant bacteria down into four categories depending on how they affect the antibiotics used for treatment:
● Limiting a drug’s uptake
● Modifying the drug target
● Inactivating the drug
● Active drug efflux
Preventing a COVID-related antimicrobial resistance
As the world approaches the end of 2021, the COVID-19 pandemic is still ongoing. New variants are emerging, and it is becoming increasingly apparent that this virus may become endemic like the influenza virus. In spite of nearly two years of treatment experience, there are many countries that are recommending antibiotic therapy or even prophylaxis for COVID-19 patients, even if there is no justification to do so. This widespread and often indiscriminate use of antibiotics is setting the stage for antimicrobial resistance.
The best tool to prevent a COVID-related case of antimicrobial resistance is to create standardized treatment plans that can be used worldwide. It is possible for patients to acquire a bacterial coinfection during the course of their treatment, but that does not justify preemptively treating everyone with antibiotics. Confirmation of a bacterial infection, such as bacterial pneumonia, which has been seen commonly alongside COVID-19, should be necessary before any antibiotics are prescribed.
Improved diagnostics could help prevent antimicrobial resistance issues by speeding up the treatment timeline. Traditionally, bacterial infections require cultures that can take 48-72 hours to show results — or longer with some organisms. Methods that can detect and identify bacterial infections more rapidly, could help prevent some of the prophylactic “just in case” antibiotic treatments while ensuring that those who do present with bacterial coinfections get the antibiotics they need in a timely manner.
It is also important to utilize antimicrobial treatments that will impact the desired areas. Vancomycin, for example, is a frequently prescribed antibiotic, but only targets bacteria in the intestines when taken by mouth. An accurate AUC24 calculation is also essential after a bacterial infection is confirmed to ensure the patient is receiving the treatment they need without flooding them with antimicrobials and creating more problems than they solve.
Studies have shown that less than 10% of hospitalized COVID-19 patients treated with antibiotics presented a bacterial coinfection. This widespread antibiotic use is the sort of thing the industry should avoid to prevent the creation of another antimicrobial-resistant superbug.
Looking toward the future
COVID-19 is not going anywhere anytime soon, but the widespread treatment of a viral infection with antibiotics isn’t going to speed that up. Instead, it could set in motion a chain of events that could potentially knock modern medicine back into the dark ages. It’s been estimated that if no action is taken, drug-resistant infections could cause 10 million fatalities a year by 2050.
Changes need to be implemented as soon as possible to prevent a COVID-related antimicrobial resistance from developing. On paper, it sounds simple: stop proactively prescribing antibiotics until a bacterial coinfection is confirmed. Transitioning these changes from suggestion to reality on a global scale will be much more challenging.