Written by Dibash Kumar Das, Ph.D. on August 29, 2020 – Fact verified by Rita Ponce, Ph.D.
The use of antibiotics in people with COVID-19 can lead to increased antimicrobial resistance (AMR). This can mean that bacteria become resistant to antibiotics. The effects can be felt among the general population and have toxic consequences for the environment.
This is the main conclusion of new research conducted by a team from the University of Plymouth and the Royal Cornwall Hospitals Trust, both in the UK. The findings appear in the Journal of Antimicrobial Chemotherapy .
COVID-19 has created major problems for social and health systems worldwide, and the spread of AMR is a possible consequence.
Although antibiotics are not used to treat illnesses caused by viruses, patients hospitalized with coronavirus infections may receive a combination of these medications to prevent secondary bacterial infections. This can have serious effects on antimicrobial resistance (AMR).
“Like other hospitalized patients in the UK and other countries, most of our patients with COVID symptoms were prescribed antibiotics because it is very difficult to know whether a patient presenting with COVID symptoms has an underlying bacterial infection or not,” says Neil Powell, author of the research and consultant pharmacist at the Royal Cornwall Hospitals Trust.
Concern about resistance has led the World Health Organization (WHO) to discourage the use of antibiotics for mild cases of COVID-19, although they still recommend their use for people with severe COVID-19 who are at risk of secondary bacterial infections and death.
Negative impact on the environment?
This research revealed that the increased use of antibiotics during the pandemic may also place an additional burden on wastewater treatment works.
The team noted that this could lead to elevated levels of antibiotics in UK rivers and coastal waters, which in turn may result in an increase in AMR.
This would be particularly serious in receiving waters of these works that serve large hospitals or emergency hospitals, where there are high concentrations of COVID-19 patients.
Amoxicillin and ADR: an environmental concern?
Thomas Hutchinson, professor of environment and health at the University of Plymouth and lead author of the research, says: “The amoxicillin data indicated that while there was little threat of direct impacts on fish and other wildlife populations, there is potential environmental concern for AMR selection if it is at 100% capacity.”
"From our previous research, we know that significant amounts of commonly prescribed drugs pass through treatment works and into our waterways," adds Sean Comber, professor of environmental chemistry at the university and lead author of the paper.
“By developing a greater understanding of its effects, we can potentially inform future decisions about prescribing during pandemics, but also about the location of emergency hospitals and the wider management of medicines and waste,” says Prof. Comber.
Mathew Upton, co-author and professor at the university's School of Biomedical Sciences, concludes: "Antibiotics are the foundation of all modern medicine, but AMR is a problem that could affect millions of lives in the coming decades."
Currently, the COVID-19 pandemic is causing immense suffering and loss of life worldwide, but antimicrobial resistance (AMR) has been, and will continue to be, one of the most significant threats to global human health. We conducted this study so that we can begin to understand the broader impact of global pandemics on human health.
Finally, Professor Upton says, “It is clear that the mass prescription of antibiotics will lead to increased levels in the environment, and we know that this can select for resistant bacteria. Studies like this are essential so that we can plan how to target antibiotic prescribing in future pandemics.”