key: cord-0906554-wz1jqy07
authors: Rana, Muhammad Suleman; Usman, Muhammad; Salman, Muhammad; Alam, Muhammad Masroor; Ikram, Aamer; Umair, Massab; Faryal, Rani; Anas, Muhammad; Qadir, Mehmood
title: Potential impact of COVID-19 Pandemic on escalating antimicrobial resistance in Pakistan
date: 2021-07-28
journal: J Infect
DOI: 10.1016/j.jinf.2021.07.024
sha: ee66a71b656895b34db450c8e147a764ce8d103b
doc_id: 906554
cord_uid: wz1jqy07

nan

In the shadow of COVID-19 Pandemic, there has been another ongoing pandemic of antimicrobial resistance (AMR). It is likely that the COVID-19 pandemic is fueling the emergence of antimicrobial resistance due to high rate of inappropriate use of antibiotics worldwide. World Health Organization (WHO) has places antimicrobial resistance among the top 10 most urgent health threats to mankind [3] .

Antimicrobial resistance (AMR) has emerged as one of the principal public health disaster of the 21st century that threatens the effective prevention and treatment of an ever-increasing range of infections caused by bacteria, parasites, viruses and fungi no longer susceptible to the common medicines used to treat them. The problem of AMR is especially urgent regarding antibiotic resistance in bacteria. Antimicrobial resistance poses a serious threat to global public health with long term negative humanitarian and economic consequences. It is estimated that drug resistant infections already kill more than 700,000 people per year around the world and if this threat left unchecked it could kill 10 million people per year by 2050 [4] . The COVID-19 pandemic could lead to a further increased the over and misuse of antibiotic, possibly resulting in subsequent emergence and further high level spread of antibiotic resistance. Current scientific literature suggests that only 8% of hospitalized COVID-19 patients experience a bacterial or fungal co-infection, however 72-90% of these patients receive antibiotic treatment [5] . Wide spread use of antibiotics increases the likelihood of bacteria becoming resistant with catastrophic effect.

COVID-19 pandemic has not only exposed health system challenges but also exacerbated other public health crises such as AMR in poor countries including Pakistan.

In Pakistan, the percentage of antimicrobial resistance is already very high and COVID-19 pandemic further increases the percentage of AMR to the alarming level which could spell the serious disaster on the fragile health care system of the country. In Pakistan, the 65% increase in the consumption of antibiotics was reported between, 2000-2015. More than 500,000 people, annually die in Pakistan due to medication errors such as wrong prescription, overdose of drugs and selfmedication [6] . Although unmeasured, there is a chance that a high proportion of people are taking antibiotics in misguided attempts such as self-medication. Such practices would likely be more prevalent in developing countries including Pakistan where antibiotics are easily obtained without a prescription. In June 2020 in Pakistan, with the up-surge of COVID-19 cases during the first wave of pandemic, the consumption of antibiotics increased 23.3% as compared to January 2020. The consumption of azithromycin in June 2020 was at 88.6% from January 2020 [7] .

China. It is already reported that there are more than 600,000 non-registered medical practitioners and 70,000-80,000 unqualified quacks involve in illegal medical practice in Pakistan [6] .

In Pakistan antimicrobial resistance has been recognized as a national concern since 2014. However, challenges in efforts to stringently monitor the consequences of the spread of AMR have not been consistently and substantially addressed at a national level. The mapping of AMR in the absence of a well-established surveillance network, has meant that AMR information, at national level is not available. Pakistan is the fifth country in the world with highest burden of tuberculosis and over 27000 drug Greater efforts are require to preserve antimicrobial stewardship measures during COVID-19 pandemic and future outbreaks and epidemics. In addition, educating healthcare professional and general public is critical, especially given the misinformation circulating on social, electronic and print media about potential treatment for COVID-19, including antibiotics.

Underestimation of co-infections in COVID-19 due to nondiscriminatory use of antibiotics

World Health Organization: Antimicrobial resistance

Drug-resistant infections in the time of COVID-19: Available at

Coronavirus pandemic is paving the way for an increase in superbugs: Available at

Over-the-counter medicines in Pakistan: misuse and overuse. The Lancet

An Overview of the Treatment Options Used for the Management of COVID-19 in Pakistan: Retrospective Observational Study. JMIR Public Health Surveill

All author declared that there is no conflict of interest