INTRODUCTION:

Antibiotic resistance stands as a formidable public health challenge, representing one of the paramount issues of our era¹. The World Health Organization (WHO) has unequivocally identified antibiotic resistance as a global threat to humanity. The global landscape of healthcare is intricately intertwined with the indispensable role of antimicrobials, encompassing antibiotics, antivirals, and antifungals. These pharmaceutical agents constitute essential medicines that play a pivotal role in preventing and treating infections, thereby enhancing morbidity and mortality outcomes. Beyond their direct impact on individual health, antimicrobials also serve as critical facilitators of modern medicine, underpinning the foundations of emerging healthcare systems worldwide².

The misuse and overuse of antibiotics have contributed significantly to the emergence and spread of antibiotic-resistant bacteria, posing a substantial threat to global health. A remarkableaspect of this predicament is the concerning prevalence of unnecessary or inappropriate antibiotic prescriptions within hospital settings, where an estimated 25–50% of antimicrobials are administered in ways that directly fuel antibiotic resistance^3,4.

The COVID-19 pandemic has brought unprecedented challenges to global healthcare systems, placing an immense strain on an already precarious drug supply chain⁵. As the world grapples with the complexities of managing the pandemic, attention has turned to the intricate interplay between the novel coronavirus and antibiotic consumption. This unique set of circumstances has given rise to critical considerations regarding the utilization of antibiotics during the COVID-19 era and its potential ramifications on global health. The advent of the COVID-19 pandemic has cast a spotlight on the intricate relationship between infectious diseases, antibiotic consumption, and global health. Experts and healthcare professionals have raised alarms about the potential exacerbation of antibiotic resistance due to the unprecedented healthcare challenges posed by the pandemic⁶. The urgency of addressing antibiotic overuse has become more pronounced in the wake of COVID-19, as the healthcare system has faced unprecedented strains, and there is a heightened risk of inappropriate antibiotic prescriptions in the quest to combat the virus.

As the world navigates these challenges, recent studies have raised alarm bells regarding the potential negative consequences of the pandemic on antibiotic Resistance^7,8. While some developed countries, including the United Kingdom, Netherlands, New Zealand, Canada, and the United States, reported decreases in antibiotic prescribing during the pandemic, a significant gap in knowledge exists concerning the global and regional effects of the pandemic on antibiotic consumption, especially in developing countries^9,10,18. While the data available from hospital-based studies conducted in Lebanon, Spain, Italy, India, Brazil, China, UK^11,12,13and community antibiotic consumption studies conducted in Jordan, Australia, Canada, Portugal, Spain, UK, Japan, and EU shows increase in antibiotics^14,15,16,23.

Antibiotic -resistant bacterial infections, arising from the misuse and overuse of these crucial medicines, pose a substantial risk to public health on a global scale. these infections are associated with prolonged hospital stays, elevated treatment costs, and heightened mortality rates, marking antimicrobial resistance as one of the most significant challenges in contemporary global health¹⁷. The alarming toll of deaths caused by or associated with antimicrobial resistance bacterial infections is particularly pronounced in Sub-Saharan African countries, underscoring the urgent need for comprehensive strategies to address this pressing issue^19,20. Recent studies conducted across various countries have illuminated a concerning trend a surge in antibiotic consumption within Intensive Care Units (ICUs) during the COVID-19 pandemic. This increase in antibiotic use is not only indicative of the unique challenges posed by the viral outbreak but also raises critical questions about the long-term impact on global health. Understanding the dynamics of antibiotic consumption during and after the COVID-19 pandemic is, therefore, essential to mitigating the risks associated with antibiotic overuse, safeguarding the efficacy of these vital drugs, and preserving the effectiveness of healthcare interventions on a global scale. In this context, the following research endeavors to delve into the intricate relationship between antibiotic consumption during COVID-19 and its lasting implications on global health^21,22,23,24.

One notable facet contributing to the heightened demand for antibiotics during the pandemic is the emergence of recommendations for the use of azithromycin early in the course of COVID-19. Azithromycin, originally an antibiotic designed to combat bacterial infections, gained attention for its potential antiviral properties and was proposed for use in COVID-19 management protocols. The adoption of such recommendations, coupled with concerns about secondary bacterial infections among patients hospitalized with COVID-19, may have fueled an upsurge in the demand for antibiotics^25,26. The pattern shift towards virtual healthcare in response to the pandemic has reshaped patient-doctor interactions, influencing prescribing practices. Telemedicine and remote consultations, while essential for minimizing the spread of the virus, may have inadvertently contributed to changes in antibiotic prescription patterns. Understanding the dynamics of these shifts in healthcare delivery is crucial in assessing their impact on antibiotic consumption²⁷.

The overuse of antibiotics stands out as a prominent factor contributing to the acceleration of antibiotic resistance. The urgency of addressing this challenge is further underscored by the immediate surge in antibiotic use observed during the initial wave of the COVID-19 pandemic^28,29. This escalation was, in part, driven by the imperative to treat bacterial coinfections among COVID-19 patients. As the world grappled with the challenges posed by the novel coronavirus, the dynamics of antibiotic consumption underwent a rapid and significant transformation, warranting a thorough examination of its implications on global health^30,31.

This research aims to delve into the intricacies of antibiotic consumption during the COVID-19 pandemic, exploring the underlying factors that led to the surge in usage. By examining the nuanced factors influencing antibiotic demand and utilization, and unraveling the patterns and drivers of antibiotic use during this unprecedented period, the study seeks to shed light on the potential impact of such consumption on the global landscape of health. Through a comprehensive analysis, we aim to contribute to the broader understanding of the interplay between infectious diseases, antibiotic usage, and the looming threat of antibiotic resistance, with implications for shaping future healthcare policies and practices.

Potential for Increased Antibiotics Resistance and Consequences:

The increased and often indiscriminate use of antibiotics during the COVID-19 pandemic raises concerns about the potential acceleration of antibiotic resistance. In response to recent concern about the growing impact of antibiotic resistance in clinical practice, with antibiotics being a cornerstone in the treatment of bacterial infections, the risk of resistance has substantial consequences^32,33. The overuse or misuse of antibiotics can lead to the survival and proliferation of resistant strains of bacteria, rendering once-effective antibiotics ineffective. This not only complicates the treatment of common infections but also increases the risk of severe complications and mortality. it is now widely accepted that more stringent measures, intended to reduce antibiotic misuse, are urgently required to deal with this problem^34,35,36.

There are several factors behind the expression of antibiotic resistance against antibiotics or antimicrobial agents, including the degree of resistance expression of the bacterial strain and its ability to survive through resistance mechanisms^37,38. Over-reliance on Antibiotics in COVID-19 treatment, during the early phases of the pandemic, there was an excessive use of particular antiviral medications for COVID-19. This resulted in the experimental application of antibiotics to treat secondary bacterial infections or as a preventative measure, which contributed to the overall increase in antibiotic usage. One of the most significant issues connected with antibiotic resistance is the inadequate rate of new antibiotic investigation. Several pharmaceutical companies chose to withdraw from antibiotic research and development due to the medications' low profitability³⁹.

The increasing risks of adverse effects, antibiotic resistance, and result failure have presented financial problems for drug research and therapy. The breakdowns in medical care, increased stress on healthcare systems, and changes in prescribing practices during the epidemic have all contributed to a situation that encourages antibiotic overuse. Antibiotic resistance can also be caused by genetic alterations encoded on the bacterial chromosome, which occur as a result of the evolution of antibiotic-resistant genetic material and its transmission to the next generation. As a result, the bacterium becomes less vulnerable to the antibiotic's effects, resulting to resistance^40,41. The bulk of newly produced antibiotics lack the novel modes of action or unique chemical compositions that attack well-validated targets required to significantly ensure their efficiency against resistant organisms⁴². Understanding the interaction of these elements is key in appreciating the consequences for future healthcare and the possible acceleration of antibiotic resistance. Other most pressing concerns about antibiotic resistance is the medications' declining efficacy in treating common and previously curable diseases. As resistance grows, healthcare professional’s arsenal of effective medicines decreases, making combating contagious infections more difficult. The rise of antibiotic-resistant bacteria can result in longer illnesses, more severe infections, and greater fatality rates. Patients with impaired immune systems, such as those undergoing chemotherapy or organ transplants, are especially prone to infections that were previously treatable with drugs.

METHODOLOGY:

An electronic literature search was carried out; specific search terms and phrases were used to narrow the search and turn up a wide range of relevant research. "Antibiotic consumption," "coronavirus" or "COVID-19," "antimicrobial resistance," and "antibiotics resistance" were among the main phrases. These keywords were chosen with carefully to cover a wide range of topics pertaining to the interaction between antibiotic use, viral infections, and antimicrobial agents during the COVID-19 pandemic. This systematic approach to the literature search demonstrates an in-depth evaluation of essential topics within the scope of the research, as well as ensuring the inclusion of recent and relevant studies. Utilizing digital databases such as Scopus, Web of Science, PubMed and targeted search phrases improves the findings, validity and dependability, laying the groundwork for a thorough examination of antibiotic use during the COVID-19 pandemic and its effects on global health. These databases were selected based on their thorough coverage of scholarly literature and credibility as information sources. In order to ensure relevance to the present global health situation, the search was limited to publications published since the outbreak of the COVID-19 pandemic.

All papers that are published in English that discussed COVID-19 patients from hospitals and communities and who were provided antibiotics during their treatment were included. We looked for research on the use of antibiotics in COVID-19 patients that included cohort studies, cross-sectional studies, case-control studies, randomized control studies, descriptive studies, case reports, reviews, opinions, or study protocols, as well as retrospective and longitudinal studies and observational research. We also took into account the research that mentioned the use of antibiotics without identifying the types or results of the treatments. The study also included all records of antibiotics prescribed systemically for human use.

To ensure the reliability and significance of the study of antibiotic resistanceand antibiotic consumption during the COVID-19 pandemic and its impact on global health, we systematically filtered and eliminated specific research studies. One important criteria for exclusion was the detection of overlapping studies, to ensure the integrity of our dataset, we purposefully excluded research studies that presented duplicate data, as redundancy might compromise the accuracy of the results. This phase was critical for streamlining our research and minimizing duplicate in our examination of current material likewise, we excluded studies that contained unreliable data, particularly those characterized by short reports lacking proper results. Recognizing the importance of reliable and credible data in informing our research, we choose to focus on studies with complete and significant findings. This standard made to improve the quality and reliability of the data used in our research, ensuring that our conclusions and insights were founded on solid scientific evidence. Furthermore, we deliberately excluded research findings published as editorials and notes. While these types of publications add essential insights and views to scientific discourse, they may lack the depth of empirical data required for our study goals.

We made sure that our analysis remained relevant to the core issue of our investigation by narrowing our focus to studies that directly connect antibiotics or antimicrobials with COVID-19. However, the research pertaining to pharmacological modeling, animal experimentation, molecular mechanisms, and other elements of COVID-19 were purposefully excluded from our study unless they expressly addressed the use of antibiotics or antimicrobials, considering the COVID-19 pandemic, this selective approach allowed us to focus on the elements most directly related to our study issue, allowing for a more in-depth and analytical analysis of antibiotic use patterns and their consequences for global health.

RESULT AND DISCUSSION:

The observed trends in antibiotic consumption during and post-COVID-19 signal potential threats to global health. The overconsumption of antibiotics, particularly during the pandemic, raises alarms due to its broader health implications. Another main concern resulting from increased antibiotic usage is the accelerated development of antimicrobial resistance.

From the data analyze, we can conclude that compared to 2019, there was an apparent spike in the number of patients using antibiotics in 2020 and 2021. The little increase in the number of prescribed antibiotic types indicates that antibiotic abuse and overuse are common. The extensive consumption of antibiotics has raised concerns about antibiotic resistance, especially since the start of the COVID-19 pandemic. Increased antibiotic use disrupted the delicate balance of microbial ecosystems in the human body, leading to numerous health consequences. Antibiotic-resistant strains of bacteria are mostly the result of overuse and misuse of antibiotics. Antibiotic-resistant microorganisms pose a serious threat to public health in future because they reduce the efficiency of available antibiotics, making treatment of bacterial infections more difficult. This can therefore result in higher death rates and longer-lasting illnesses

The study's findings also indicate that the indiscriminate use of antibiotics may reduce their ability to effectively treat bacterial illnesses. This is especially concerning because it makes treating common infections more difficult, which could result in a higher rate of treatment failures. Regular medical operations, including surgeries and cancer treatments, become riskier in the absence of efficient antibiotics because of the increased risk of bacterial infections. A significant increase in antibiotics consumption within ICUs during the COVID-19 pandemic is also seen. The trends of antibiotic consumption that have been observed are globally indicating that the effects of antibiotic overuse and resistance are not limited to certain geographical areas.

Variation by region in the prescription of antibiotics is observed, it reveals geographical differences in the practices of administering antibiotics, pointing to a dynamic and complicated environment. Data study also reveals that prescription patterns fluctuate between geographical regions, indicating the impact of regional variables on antibiotic use. Understanding the variations in prescribing and consumption is crucial for designing targeted interventions to address antibiotic misuse and overuse. Both developed and developing countries shows over 78% of COVID-19 patients were recommended to use antibiotics, indicating a widespread practice in the clinical practice of COVID-19 cases.

Because of the adoption of virtual healthcare platforms, it brought about substantial changes in antibiotic prescription practices. telemedicine and remote consultations, which are essential for minimizing the spread of the COVID-19, might have inadvertently influenced antibiotic prescription patterns. The lack of direct physical examination and diagnostic tests may have influenced prescribing decisions, including the prescription of antibiotics. The remote nature of consultations has led to a more cautious approach in some cases, while in others, it could have contributed to the overprescription of antibiotics, driven by uncertainties in diagnosing infections without traditional clinical assessments.

Among COVID-19 patients, azithromycin and other broad-spectrum antibiotic, was found to be the most commonly recommended medication. Amoxicillin, Clarithromycin, Doxycycline, Levofloxacin, Moxifloxacin, Ciprofloxacin, Erythromycin, Trimethoprim/ Sulfamethoxazole, Ceftriaxone, Cefuroxime, Cefpodoxime, Amoxicillin/ Clavulanic Acid, Clindamycin, Minocycline, Linezolid, Telithromycin, Vancomycin, Meropenem, Cefixime, Polymyxin B, and piperacillin were the most used antibiotics, there was statistically significant growth in polymyxin B, polymyxin E, daptomycin, amikacin, and amphotericin are other frequently recommended antibiotics that demonstrate the variety of medicines used in COVID-19 treatment.

CONCLUSION:

The study provides a critical examination of the impact of the COVID-19 pandemic on global antibiotic consumption, revealing significant trends and potential consequences for public health. The results highlight an apparent spike in antibiotic use during the pandemic, illustrating the complex relationship between the new coronavirus and antibiotic use. Even if the global consumption of antibiotics increased overall in 2019 to 2021, a positive trend with a worldwide decrease in antibiotic use occurred after the pandemic. It is imperative, to recognize the small variations between the various nations, as a few demonstrated an alarming increase in antibiotic use in spite of the general downward trend.

Azithromycin is most frequently prescribed drug, particularly when it comes to treating COVID-19. In contrast to predictions, the study indicates that the prescription of antibiotics specifically, azithromycin was not always associated with the severity of the illness. Patients with minor symptoms were frequently provided antibiotics, which highlights areas where prescription practices should be improved during pandemic-related healthcare issues, and because of overuse of antibiotics the worldwide public health is seriously threatened by this decline in antibiotic efficacy, which can result in protracted diseases, higher treatment expenses, and higher death rates.

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Received on 19.02.2024 Modified on 16.05.2024

Res. J. Pharmacology and Pharmacodynamics.2024;16(3):233-238.

DOI: 10.52711/2321-5836.2024.00039