UKZN warns of antibiotic danger in Covid-19 treatment

University of KwaZulu-Natal (UKZN) academic and the South African Research Chair in Antibiotic Resistance, Professor Sabiha Essack, is calling on healthcare providers to exercise prudence if/when prescribing antibiotics to Covid-19 patients.

Essack, together with collaborating scientists in the international AntiMicrobial Resistance (AMR) Insights ambassador network, Dr Ariel Blocker and Dr Maarten Van Dongen, has expressed concern that the inappropriate use of antibiotics in the treatment of Covid-19 could lead to antibiotic resistance among patients.

Essack says that the causal relationship between inappropriate antibiotic use and antibiotic resistance has been well established in both hospital and community settings.

“It is therefore essential that all healthcare providers treating Covid-19 patients, implement diagnostic stewardship/microbial diagnostics and exercise prudence in prescribing antibiotics so as not to unintentionally exacerbate antibiotic resistance.”

According to the World Health Organisation (WHO), most people infected with the virus are expected to experience mild to moderate respiratory illness and recover without requiring special treatment.

Those more likely to develop serious illness include the elderly and those with underlying medical conditions such as cardiovascular disease, diabetes, chronic respiratory disease and cancer.

In the absence of a specific vaccine or treatment for the virus, many healthcare providers have been prescribing anti-retrovirals, anti-malarials and antibiotics either singly or in combination to manage Covid-19 patients.

Essack, Blocker and Van Dongen argue that there is minimal robust evidence to support the use of such treatments.

Essack says there are various studies undertaken across the globe which indicate the inappropriate use of antibiotics including a single center study of 99 Covid-19 patients in Wuhan, China where 71 % of patients were prescribed antibiotics despite elevated procalcitonin levels being recorded in only 6 % of patients and bacterial co-infection in a mere 1%.

Another example she mentions is of the first 12 Covid-19 patients in the United States who received empiric antibiotic treatment for possible secondary bacterial pneumonia in the absence of bacterial co-infection. 

Referring to WHO guidelines, Essack says antibiotics do not work against viruses, only bacteria.

“Since Covid-19 is a virus, antibiotics should not be used as a means of treatment or prevention.”

Essack, Blocker and Van Dongen further endorse the 4 Rs of antibiotic stewardship where the “Right antibiotic is prescribed at the Right dose and administered at the Right time for the Right duration so as to promote rapid recovery from infection, prevent antibiotic resistance and reduce health care costs.”