Pandemic fuels antibiotic misuse and drug resistance in India

July 8, 2021

The COVID-19 catastrophe in India has resulted in more than 30 million people infected with the virus and nearly 400,000 deaths, though experts are concerned that the figures most likely are much higher. Meanwhile, another public health crisis has emerged along with COVID-19: the widespread misuse of antibiotics.

During India’s first surge of COVID-19, antibiotic sales soared, suggesting the drugs were used to treat mild and moderate cases of COVID-19, according to research led by Washington University School of Medicine in St. Louis as reported in a news release.

“Antibiotic resistance is one of the greatest threats to global public health,” said Infectious Diseases Specialist Sumanth Gandra, MD, Associate Professor of Medicine and Associate Hospital Epidemiologist at Barnes-Jewish Hospital.

The study, conducted in collaboration with McGill University in Canada, is published in PLOS Medicine.

In high-income countries such as the United States, United Kingdom and Canada, overall antibiotic use plunged in 2020, even during COVID-19 peaks. “This is because physicians in high-income countries generally did not prescribe antibiotics for mild and moderate COVID-19 cases,” Gandra explained. “The uptick in India indicates that COVID-19 guidelines were not followed.”

To assess the pandemic’s impact on antibiotic use, researchers analyzed monthly sales of all antibiotics in India’s private health sector from January 2018 through December 2020. The data came from an Indian branch of IQVIA, a U.S.-based health information technology company.

Specifically, researchers examined the total sales volume of all antibiotics as well as the individual sales volume for azithromycin. The latter was studied because some countries experienced a spike in azithromycin sales early in the pandemic after observational studies suggested the antibiotic could help treat COVID-19 (Subsequent studies disputed the claim).

The researchers determined that a total of 16.29 billion doses of antibiotics were sold in India in 2020, which is slightly less than the amounts sold in 2018 and in 2019. However, when researchers focused on adult doses, usage increased from 72.6% in 2018 and 72.5% in 2019 to 76.8% in 2020.

Additionally, sales of azithromycin for adults in India increased from 4% in 2018 and 4.5% in 2019 to 5.9% in 2020. The study also showed notable increases in the sales of doxycycline and faropenem, two antibiotics commonly used to treat respiratory infections.

After statistically adjusting for seasonality and mandatory lockdown periods, researchers estimated that COVID-19 likely contributed to 216.4 million excess doses of antibiotics for adults and 38 million excess doses of azithromycin for adults from June 2020 through September 2020, a four-month period of peak COVID-19 activity in India.

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