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Antibiotic Overuse Adds to Pandemic Worries

Most COVID-19 patients don't need antibiotics to get better, but some doctors are prescribing them just in case

By Stephenie Overman

The overuse of antibiotics during the pandemic may make other types of microbes (bacteria causing diseases) an even bigger threat. Antibiotics are not effective against viruses. Doctors prescribe antibiotics to treat secondary bacterial infections that may develop alongside the virus, but they are often used when not needed. Some doctors say it will take government intervention to solve the urgent problem of drug-resistant infections.

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A display of MRSA (Methicillin-resistant Staphylococcus aureus) bacteria strain inside a petri dish. MRSA is a drug-resistant "superbug", which can cause deadly infections.   |  Credit: Photo by Fabrizio Bensch/Reuters via PBS NewsHour

Data suggest that 50% to 75% of COVID-19 patients received antibiotics when hospitals were slammed with cases last spring. Months later, researchers determined that the incidence of bacterial infections among COVID-19 patients is only around 15% or so, says Dr. Cornelius Clancy, associate chief at the VA Pittsburgh Health System.

"It's fair to say antibiotic overuse was a problem before COVID-19."

The reason so many antibiotics have been given to COVID-19 patients is that doctors didn't know if their patients had secondary bacterial infections and didn't want to waste time figuring it out before they treated them because the patients were so sick. But once you start an antibiotic, you need to finish it or resistance can develop.

Antibiotic-resistant bacteria can turn routine infections into life-threatening illnesses. Each year, about 2.8 million Americans become infected with so-called "superbugs" and 35,000 die, according to the Centers for Disease Control and Prevention.

"There was a honeymoon period where people thought that there would always be a new drug [antibiotic], but that's started to dry up," says Muhammad Zaman, professor of biomedical engineering and international health at Boston University. "Bacteria becomes more resistant. The arsenal is becoming smaller and smaller," he adds.

It's unclear just how much worse the superbug problem has become during the pandemic. "About half of all patients in U.S. hospitals before COVID-19 received antibiotics," says Clancy. "So, it's fair to say antibiotic overuse was a problem before COVID-19, is a problem during COVID-19 and will be a problem afterwards." 

Antibiotic-resistant pathogens are a particular danger to older people.

"Superbugs often emanate from the health care system," says Dr. Wafaa El-Sadr, a professor of epidemiology and medicine at Columbia University and director of the Global Health Initiative at its Mailman School of Public Health. "Older individuals are vulnerable because they have more contact with the health care system overall. They need to be hospitalized more often."

Hospitals are a major source of exposure to dangerous pathogens for older people, especially after surgery. So are nursing homes and other care facilities, says Zaman, author of "Biography of Resistance: The Epic Battle Between People and Pathogens." Notes Zaman: "Any place where you have high density and have people already infected."

The Quest for New Antibiotics

A critical component in the fight against bacterial superinfections is replenishing the arsenal of effective antibiotics, but it's a complex task, writes Dr. David Hyun, head of The Pew Charitable Trusts' Antibiotic Resistance Project.

"Current market dynamics combined with scientific challenges have led to a mass exodus of major pharmaceutical companies from antibiotic research and development," notes Hyun. The capacity and expertise needed to focus aggressively on drug discovery and development is dwindling rapidly, he adds.

What's needed, according to Hyun and other scientists, is a concerted government investment effort, similar to the one to develop COVID-19 vaccines.

Lawmakers have introduced bills in Congress to strengthen the antimicrobial research and development pipeline. The PASTEUR Act would provide subscription-based government contracts for access to high-priority antibiotics. The DISARM Act would encourage antibiotic innovation.

Several government and public-private programs have successfully ushered new antibiotics out of the laboratory into clinical studies, says Clancy. "What's also important," he adds, "are new reimbursement models that are not linked to the number of sales of a given antibiotic."

Instead, incentives should focus on paying for the antibiotics that are needed most, he says, while discouraging the use of antibiotics when they are not needed. "A simple payment model based on filling the largest number of prescriptions as possible does not work," says Clancy. "New antibiotics are public resources, which are a foundation of modern medicine, and we need to support their development while limiting their unnecessary use."

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Taking Antibiotics Responsibly

Defending ourselves against superbugs is in some ways the same as defending ourselves against COVID-19. The increased use of face masks, social distancing and hand washing comes with a silver lining, says El-Sadr, because these practices also prevent the transmission of other pathogens.

To protect loved ones from the dangers of both bacterial superinfections and COVID-19 in long-term care facilities, where the risks of exposure are higher, Zaman recommends a series of questions to ask:

Do [facilities] have access to people who have studied the likelihood of infection in that place?

Are infectious disease experts speaking there, giving practical advice?

Are there infection control mechanisms in place to minimize [resident] exposure to other people?

Is the facility clean in a broader sense?"

To fight superbugs in our communities, Clancy says there's one thing we must all understand and share with others: antibiotics have no role in treating viral infections like COVID-19 and using them against viral infections will lead to more antibiotic resistance while carrying a risk for adverse reactions to the antibiotics.

"There are no benefits to the person taking them," she says, "But [the drugs pose] risks to both the person and society. It's okay for your doctor not to give you an antibiotic if you are diagnosed with COVID-19!"

Stephenie Overman
Stephenie Overman writes about workplace and health issues. She is the author of Next-Generation Wellness at Work. Read More
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