New evidence from the World Health Organisation (WHO) has shown that extensive overuse of antibiotics during the COVID-19 pandemic worldwide has exacerbated the ‘silent’ spread of Antimicrobial Resistance (AMR).
   
While only eight per cent of hospitalised patients with COVID-19 had bacterial co-infections requiring antibiotics, three out of four or some 75 per cent of patients have been treated with antibiotics ‘just in case’ they help.
  
According to WHO, antibiotic use ranged from 33 per cent for patients in the Western Pacific Region, to 83 per cent in the Eastern Mediterranean and the African Regions. The global health body noted that between 2020 and 2022, prescriptions decreased over time in Europe and the Americas, while they increased in Africa.
   
The highest rate of antibiotic use was seen among patients with severe or critical COVID-19, with a global average of 81per cent. In mild or moderate cases, there was a considerable variation across regions, with the highest use in the African Region (79 per cent). 
  
WHO classifies antibiotics as per AWaRe (Access, Watch, Reserve) classification, according to the risk of AMR. The study found that ‘Watch’ antibiotics with higher resistance potential were most frequently prescribed globally.
  
WHO Unit Head for Surveillance, Evidence and Laboratory Strengthening, Division for AMR, Dr Silvia Bertagnolio, stated that when a patient requires antibiotics, the benefits often outweigh the risks associated with side effects or antibiotic resistance adding that when they are unnecessary, they offer no benefit while posing risks, and their use contributes to the emergence and spread of antimicrobial resistance.
  
She observed that current data calls for improvements in the rational use of antibiotics to minimise unnecessary negative consequences for patients and populations.”
  
Bertagnolio explained that overall, antibiotic use did not improve clinical outcomes for patients with COVID-19 but rather, it might create harm for people without bacterial infection, compared to those not receiving antibiotics.
  
“This underscores the urgent need to improve the rational use of antibiotics to minimize unnecessary negative consequences for both patients and populations. A systematic evidence synthesis and appraisal will complement this work to inform upcoming WHO recommendations on antibiotic use in patients with COVID-19, as part of the guidelines for the clinical management of COVID-19.”
  
These findings are based on data from the WHO Global Clinical Platform for COVID-19, a repository of standardised individual-level, anonymised clinical data from patients hospitalised with COVID-19. The Data was collected from some 450,000 patients admitted to hospitals for COVID-19 in 65 countries over three years from January 2020 to March 2023.
   
WHO Assistant Director-General for ARM, Dr Yukiko Nakatani, said, “These findings underscore the important need to adequately resource the efforts to improve antibiotic prescribing globally, and are particularly relevant to discuss ahead of the upcoming UN General Assembly High-Level Meeting on AMR in September.
  
The organisation brings together global leaders to commit to mitigating AMR across human health, animal health, agri-food sectors and the environment, and to promote political leadership, financing and actions to slow the emergence and spread of AMR.