Antibiotic resistance is one of the greatest threats to global public health

    According to a research led by Washington University School of Medicine in St. Louis on Antibiotics use, the study suggests extensive use of antibiotics world over is considered inappropriate because antibiotics are only effective against bacterial infections, not viral infections such as COVID-19, and overuse increases the risk for drug-resistant infections.

    “Antibiotic resistance is one of the greatest threats to global public health,” said the study’s senior author, infectious diseases specialist Sumanth Gandra, MD, an associate professor of medicine and an associate hospital epidemiologist at Barnes-Jewish Hospital.

    “Overuse of antibiotics lessens their ability to effectively treat minor injuries and common infections such as pneumonia, which means that these conditions can become serious and deadly. Bacteria that have become resistant to antibiotics don’t have boundaries. They can spread to any person in any country.”

    The study, conducted in collaboration with McGill University in Canada, is published July 1 in PLOS Medicine. Giorgia Sulis, MD, Ph.D., a postdoctoral researcher at McGill, is the first author.

    India among the nations that in- appropriately use extensive antibiotics

    Antibiotics are life-saving medications. However, unchecked, germs learn to defy the antibiotics designed to kill them while also multiplying in force. Along with more illnesses and deaths, antibiotic resistance leads to increased hospital stays and medical costs.

    In high-income countries such as the United States, United Kingdom and Canada, overall antibiotic use plunged in 2020, even during COVID-19 peaks. “This is because physicians in high-income countries generally did not prescribe antibiotics for mild and moderate COVID-19 cases,” Gandra explained. “The uptick in India indicates that COVID-19 guidelines were not followed.”

    Also worrisome are prior data analyses concluding that COVID-19 cases and deaths in India surpass the official estimates. “In reality, the problem is likely much worse,” said Gandra, who also serves on a World Health Organization (WHO) committee focused on reducing antibiotic prescriptions in low- and middle-income countries.

    With nearly 1.4 billion people, India is the world’s second most populous country. “India is essential to study because it is the largest consumer of antibiotics in the world, and it’s basically a poster child for antibiotic misuse in low- and middle-income countries with similar health-care practices,” Gandra explained. “In general, these countries excessively prescribe antibiotics in primary care settings. Therefore, we suspect the pandemic has also spurred inappropriate antibiotic use in many low- and middle-income countries.”

    Antibiotic use increased despite guidelines from the Indian Health Ministry and WHO urging against antibiotics for mild and moderate forms of COVID-19, which account for more than 90% of the cases. “Antibiotics should only be given to patients who develop secondary bacterial illnesses,” Gandra said. “This was not the case, indicating the need for policy changes in India, especially in light of the current crisis and the possibility of a devastating third wave.”

    To assess the pandemic’s impact on antibiotic use, researchers analyzed monthly sales of all antibiotics in India’s private health sector from January 2018 through December 2020. The data came from an Indian branch of IQVIA, a U.S.-based health information technology company.

    The researchers determined that a total of 16.29 billion doses of antibiotics were sold in India in 2020, which is slightly less than the amounts sold in 2018 and in 2019. However, when researchers focused on adult doses, usage increased from 72.6% in 2018 and 72.5% in 2019 to 76.8% in 2020.


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