COVID-19 Is Exacerbating Antibiotic Use – And Antimicrobial Resistance Is Rising Fast, WHO Warns
Antimicrobials are becoming less effective at treating infections

As the COVID-19 pandemic spawns increased antibiotic use all over the world, more drug-resistant microbes are bound to bite us back , said Dr. Tedros at a WHO press conference on Monday. The repercussions on disease treatment and deaths will be severe, given that the world is running out of effective ways to treat antimicrobial resistance (AMR).

“COVID-19 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,” Dr Tedros said.  He was referring to the fact that patients seriously ill with the SARS-COV-2 virus are often receiving antibiotics to prevent secondary bacterial lung and other infections.

“As we gather more evidence, it’s clear that the world is losing its ability to use critically important antimicrobial medicines, all over the world…In some countries, there is an overuse of antibiotics and antimicrobial agents in both humans and animals,” Dr Tedros said.

That is the picture painted by the latest data updates of WHO’s Global Antimicrobial Resistance (AMR) and Use Surveillance System (GLASS).  The trends reflect ‘”disturbing” rates of increases in antimicrobial resistance, WHO says. On the positive side, participation in the surveillance has grown exponentially since the system was created in 2018.

Microbe Resistance to Some Common Drugs – Running as High as 93%

Among the worrisome indicators, the rate of resistance to ciprofloxacin, an antibiotic commonly used to treat urinary tract infections, varied from 8.4% to 92.9% in 33 reporting countries, the WHO data found.

The WHO data comes a year after the major UN interagency report “No Time to Wait” predicted that mortality from drug resistant infections could increase more than ten-fold, causing up to 10 million deaths a year by 2050, in business-as-usual scenarios.

And as antimicrobial resistance increases, the R&D pipeline to bring effective antimicrobials to the market is drying up.

“There has been very little market incentive to develop new antibiotics and antimicrobial agents, which has led to multiple market failures of very promising tools in the past few years,” Dr Tedros also said.  

Antibiotics are ubiquitous in modern medicine – They are used in most surgical procedures like joint replacement, but also in patients with conditions like cancer, cystic fibrosis or diabetes. When antimicrobials like antibiotics are used excessively, microorganisms can mutate to become drug-resistant.

R&D for antibiotics has declined for over three decades
Record Number Of Countries Are Participating In WHO’s Surveillance System For AMR

Despite the looming threat of antimicrobial resistance, a record number of countries are now monitoring and reporting antibiotic resistance through WHO’s GLASS system – marking a major step forward in the global fight against drug resistance. 

“This step is extremely important so we can look into the magnitude of the problem within different countries. And we hope that more will engage,” said WHO’s Assistant Director-General for Antimicrobial Resistance Hanan Balkhy, at Monday’s press conference.

Since 2018, GLASS has grown ‘exponentially’, she said, with over 64,000 surveillance sites, across 66 countries, as compared to only 729 sites across 22 countries when the system was founded. That led to some two million patient reports in 2020. 

AMR Is A Global Health Priority That Disproportionately Affects Low And Middle Income Countries 
Distribution of antimicrobial resistance around the world

Many low and middle-income countries already have high AMR rates – And AMR was projected to grow faster in these contexts than in high-income countries, according to a 2018 report by the Organisation for Economic Co-operation and Development (OECD).

In Brazil, Indonesia and the Russian Federation, for example, about half of infections are caused by drug resistant microorganisms – and resistance in these countries is predicted to rise 4–7 times faster than in other OECD countries.

With increasing globalization, tackling AMR is a “global health priority” because microorganisms know no borders, said Assistant Professor at Warwick University Marco Haenssgen, at a webinar on Tuesday hosted by the London School of Tropical Hygiene and Medicine.

In the late 1950’s and early 1960’s, South East Asia was one of the first regions to report about the development of drug-resistant strains of malaria (plasmodium) parasites. Since then, drug-resistant malaria has even spread to high-income countries like the UK, said Haessgen. 

Rationalizing Antibiotics Use in Humans and Animals Requires ‘Multi-Sectoral’ and ‘Customized’ Solutions
WHO Assistant Director-General Hanan Balkhy

Resolving AMR is ‘very complex’, said Balkhy, as it is ‘extremely difficult to identify’. Another issue is that the drivers of resistance are “very different” in each country.

In some contexts, AMR may be caused by over-prescription of antibiotics in human patients. In OECD countries, about half of antibiotics were inappropriately prescribed by general practitioners, which either prescribed the wrong antibiotic, or prescribed unecessarily. reported a 2018 OECD study. The same OECD study projected that AMR could cost up to $3.5 billion per year. 

In other settings and countries, AMR may be largely due to excessive use of antibiotics in agriculture. Antibiotic consumption in livestock was projected to increase by almost 70% in the most populated countries of the world by 2030, according to a 2014 study published in the Proceedings of the National Academy of Sciences. And livestock consumption of antimicrobials will be 99% higher in Brazil, Russia, India, China, and South Africa (BRICS) compared to other countries, the study estimated. 

Whether antimicrobials are used in livestock or humans, they are not a panacea for ‘good hygiene’, said Balkhy. “It is important that we do not replace good hygiene in either context by the excessive use of antimicrobials.”

WHO’s Interim Guidance on mitigating antimicrobial resistance during COVID-19

Given the complexity of the problem, the WHO has “taken a big step” to address AMR in a “customized, multi-sectoral fashion” by working directly with countries and regularly updating technical advice.

In the WHO’s latest interim guidance for clinical management of COVID-19 from late last month, it has outlined how antibiotic therapy can be used to treat patients in a way that mitigates antimicrobial resistance.

But to accelerate the development of viable candidates, new R&D models and public-private partnerships will be needed to incentivize “sustainable innovation” of newer, and more effective antimicrobials, said Dr. Tedros.

“We must bolster global cooperation and partnerships including between the public and private sectors to provide financial and non-financial incentives for the development of new and innovative antimicrobials”, added Balkhy.

Image Credits: WHO / Sergey Volkov, OECD, WHO, FAO and OIE, PNAS, WHO.