Prescription of antibiotics such as azithromycin and favipiravir to fight COVID is ‘irrational’: Experts

The World Health Organisation, recently recommended two new drugs for COVID-19, providing yet more options for treating the disease. The extent to which these medicines will save lives depends on how widely available and affordable they will be.

In India, the Central Drugs Standard Control Organisation (CDSCO) has approved anti-viral drug Molnupiravir for restricted emergency use against coronavirus. However, within a few days, the Indian Council of Medical Research had announced that this drug poses several drawbacks and is risky to use. Hence, the question arises, are these treatments viable and of any use against the present variant?

Is it safe to use antibiotics against SARS CoV-2?

A report published in Science said that antibiotics do not directly affect SARS-CoV-2, the respiratory virus responsible for COVID-19, but viral respiratory infections often lead to bacterial pneumonia. Physicians may struggle to tell which pathogen is causing a person’s lung problems. In addition to widespread overuse of antibiotics, the study shows that hospitals varied widely in their use of antibiotics among people newly hospitalised for suspected COVID-19. In some, only a quarter of suspected COVID-19 patients received them within two days of being hospitalised, while in others, nearly all did.

In a study, more than half of the patients hospitalised with suspected COVID-19 in Michigan during the state’s peak months received antibiotics early in their stay, just in case they had a bacterial infection in addition to the virus. But testing soon showed that 96.5 per cent of them only had the coronavirus, which antibiotics don’t affect.

Antimicrobial resistance is an underlying threat

Another study claims that antimicrobial resistance is a hidden threat lurking behind the COVID-19 pandemic which has claimed thousands of lives prior to the emergence of the global outbreak. With a pandemic on the scale of COVID-19, antimicrobial resistance has the potential to become a double-edged sword with the overuse of antibiotics having the potential of taking us back to the pre-antibiotic era. Antimicrobial resistance is majorly attributed to widespread and unnecessary use of antibiotics, among other causes, which has facilitated the emergence and spread of resistant pathogens.

Hydroxychloroquine, convalescent plasma therapy, ivermectin, favipiravir, doxycycline and antibiotics were widely used in the first two COVID-19 waves in India. Their efficacy was questioned at the time. But it is now known for sure that none of these have any role in the treatment for patients infected by the SARS-CoV-2 virus.

“In the first two waves, it was correct to use certain therapies as experimentation because we wanted to save lives. The key thing to remember is that we are better informed about COVID-19 treatment protocols today than ever before,” Chandrakant Lahariya, a public health analyst and epidemiologist, told Down To Earth.

Over-use of antibiotics

In India, a group of doctors from all around the world, wrote a letter to the centre and the state authorities, claiming that the mistakes from 2021, which resulted in havoc, are being repeated. This group of doctors, in the letter, were pointing at the overuse of the drugs among other things.

Research led by Washington University School of Medicine in St Louis, US, has found that sales of antibiotics skyrocketed during India’s first wave of coronavirus, suggesting that they were being used to treat COVID-19 patients.

Such use is not only ineffective – antibiotics target bacterial infections, not viral ones – but dangerous; needless or excessive antibiotic use contributes to the growing threat of drug-resistant infections worldwide.

While most of the cases reported have mild symptoms and will require little to no medication, the group of doctors who had documented their problems with COVID treatment said, “Most prescriptions we have reviewed in the past two weeks include several COVID kits and cocktails.” The prescription of vitamins and medicines such as azithromycin, doxycycline, hydroxychloroquine, favipiravir, and ivermectin is “irrational practice”, said infectious diseases specialist, Dr Madhukar Pai from McGill University, Canada. Such “wanton use of drugs” led to the outbreak of mucormycosis during the second Delta wave.