How the coronavirus crisis may feed antimicrobial resistance

Developing countries are reeling under the burden of drug-resistant infections with the rising patients of COVID-19. The coronavirus disease threatens to undermine efforts put in to control the use of antibiotics even though there is very little evidence associated with a bacterial infection. Although there are no published reports from India, anecdotal evidence suggests that bacterial co-infections are infrequent in patients with suspected severe Covid-19 requiring hospitalization. Concerns have led many hospitals to conduct a routine microbiological examination on Covid-19 patients, undermining the diagnosis and treatment of secondary infections. Since it is challenging to distinguish between bacterial or fungal infections and existing viral pneumonia based on clinical symptoms and radiological findings, the microbiological examination will be valuable for diagnosing secondary infections to guide antimicrobial prescriptions. Until there is evidence that Sars-CoV-2, the virus that causes Covid-19, is associated with bacterial or fungal co-infections, antibiotics should not be prescribed and the patients must be treated symptomatically. India has very high resistance rates to some of the broad-spectrum antimicrobials. Such antibiotics should be reserved for situations in which the differentiation between the bacterial and viral aetiology is not possible based on clinical symptoms. It is, therefore, important to define indications of antibiotic use in Covid-19 patients and follow the principles of antimicrobial stewardship.

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