Covid-19 and the antibiotics dilemma
Since the arrival of the Covid-19 pandemic, the use of antibiotics has increased exponentially across the word. Health experts have been warning that the use of antibiotics to treat Covid-19 patients without advice and prescriptions from healthcare professionals can do more harm than good. Tedros Adhanom, the Director-General of the World Health Organisation (WHO), stated earlier this month,
“The Covid-19 pandemic has led to an increased use of antibiotics, which ultimately will lead to higher bacterial resistance rates that will impact the burden of disease and deaths during the pandemic and beyond.”
Hence, the WHO has released updated guidelines regarding the appropriate use of antibiotic therapy for medical professionals who treat coronavirus patients. However, Pakistan was already facing the problem of antimicrobial resistance due to an overuse of antibiotics and antimicrobial agents. On the demand side, the unnecessary use, and at times hoarding, of antibiotics by people has been rapidly increasing in the last few months and has recently worsened due to the increased spread of coronavirus across the country.
Recently, a family friend from Pakistan said that his father and mother tested positive for coronavirus, while all other family members, which includes him, his two brothers, their wives, and two children, have Covid-19 symptoms. As a result, he said that all of them have started taking three different types of antibiotics which had been recommended to them by a person from a neighbouring family that had used the antibiotics when the individual’s family members were suffering from coughs and fever. I asked my friend whether any doctor prescribed these medications to him. He said that the medicines had not been prescribed since people are avoiding seeing doctors or going to hospitals. Thus, it seems this snowball effect of the needless intake of antibiotics is gaining momentum.
This is an extremely worrying trend in a country where an antimicrobial crisis is already looming, especially since taking antibiotics for mild symptoms of coronavirus has been highly discouraged by many medical experts. The WHO medical experts have issued guidelines to medical professionals to not provide antibiotic treatment to patients with mild Covid-19 symptoms, or to patients with a moderate illness without a clinical suspicion of bacterial infection.
Self-medication and use of medicines including herbal and traditional remedies is a common practice in Pakistan, which has been amplified by Covid-19. The use of social media has added another layer of complexity to the issue as many self-proclaimed experts are continuously advising the public to use various types of allopathic remedies, including powerful antibiotics, homeopathic and herbal medications, and home remedies to prevent and treat the coronavirus. This practice will undermine true medical efforts to control the virus.
Self-medication is a contentious practice, some experts see it as a new attitude towards health, including increased self-responsibility for health, while for others self-medication is an irrational attitude to avoid proper medical care. In the case of Pakistan, the latter is more applicable as health literacy is very low. The WHO defines health literacy as,
“The cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand and use information in ways which promote and maintain good health.”
As per the given definition, health literacy is strongly associated with the level and quality of education in the country. In Pakistan, almost every drug is sold as an over-the-counter medicine. This makes it easy for the masses to purchase antibiotics from a pharmacy or medical store without having a prescription from a doctor. Mostly, trained pharmacists do not run these medical stores; thus, no one gives proper advice to people while they buy antibiotics without any prescription.
Another key determinant of the overuse of antibiotics in the country is that often they are excessively and needlessly prescribed by medical practitioners, both in the private and public sector. Nearly 70% of the country’s population uses private healthcare, which is unregulated and infamous for its overuse of antibiotics, both orally and through injections. The same is true for the public healthcare sector. Sohail Wassan, a student of anthropology researching bioethics and the use of antibiotics, told me,
“Medical doctors have a massive influence on the lay person’s decisions and choices about their health. When the same doctors give antibiotics regularly for a seasonal flu, fever or viral infection, even if for such ailments antibiotics are not required, then ordinary people just follow the pattern.”
The excessive use of life saving drugs is not only a medical issue but also an ethical problem. These drugs are considered to be communal resources, and if people stockpile or unnecessarily use them this wastage of the resources will have social implications. A shortage could result in a price hike, thus making these antibiotics unavailable to many who may actually need them. Above all, the misuse of antibiotics enhances antibiotic resistance, which is becoming one of the biggest threats to global public health today.
To tackle this issue, serious efforts are required to develop the health literacy of the public through public service messaging and announcements. A systematic, multi-layered, targeted approach to health literacy would allow the masses access to healthcare information in order to make appropriate health-related decisions and follow instructions for adequate treatment.