Why don't antibiotics work on COVID-19?

Covid-19 and Antibiotic Resistance

What is antibiotic?

The discovery of valuable drug antibiotics is a great blessing in medical science in the 20th century. Antibiotics are drugs used to prevent the destruction of bacteria or the propagation of bacteria in both human and animal bodies. In 1928, Alexander Fleming, a professor at St Mary's Hospital in London, first discovered antibiotics known as penicillin. In reality antibiotics have made modern treatment satiated in addition to treating infectious diseases such as cancer treatment, openheart surgery, organ transplant, etc.

What is Antibiotic Resistance/Superbug?

Antibiotic resistance is a process that disrupts the activities of antibiotics. In this process bacteria are not destroyed but their propagation continues i.e. bacteria acquire a capacity that defeats the main effects of antibiotics. This antibiotic resistance is sometimes called a dreaded superbug. But many may have the misconception that antibiotic resistance means our body becoming antibiotic resistant. In fact, antibiotic resistance prevents antibiotics from bacteria that cause diseases in the body of humans or animals.

How are bacteria resistant to antibiotics?

Various techniques for causing antibiotic resistance-

1. Bacteria are resistant to antibiotics by changing the entrance of antibiotics or reducing the number of entrances. For example, in gram negative bacteria, cells prevent the entry of membrane antibiotics outside the wall.

2. Bacteria are resistant to antibiotics by throwing out antibioticcells that enter the cells using various pumps located in the cell wall. Some Pseudomonas aeruginosa bacteria flush out several important antibiotics such as beta-lactam, fluoroquinolons, chlorophyll, trimethoprime cells through the eflux pump mechanism.

3. Bacteria are resistant to antibiotics by making changes or breaks down antibiotics by creating various enzymes. Klebsiella pneumonia bacteria produce carbapanemase enzymes that destroy carbapenem and many beta-lactum antibiotics.

4. Bacteria develop new activities within cells that prevent antibiotics from carrying out their operations.

5. Bacteria are resistant to antibiotics by genetic changes in DNA and by changing the target site of antibiotics.

What causes antibiotic resistance to occur?

The reasons for the occurrence of antibiotic resistance include excessive use of antibiotics, not compiling dosageproperly, using common fever or viral flu, use of antibiotics in agriculture such as cow fattening, cattle feed, etc. However, high use of antibiotics is one of the main reasons for antibiotic resistance. Bacteria that are not destroyed by the use of an antibiotic in the first case may later be resistant to that antibiotic. Resistant bacteria can survive and breed and spread from one sick person to another. In this way, bacteria are more resistant to antibiotics when antibiotics are used repeatedly. Then it becomes very difficult to treat bacterial infections caused by those antibiotic resistant bacteria.

Antibiotic resistance is currently a common phenomenon that is the most serious threat to public health. The World Health Organization declared antibiotic resistance a 21st century global public health problem in 2017. An estimated 700,000 people are believed to die worldwide due to antibiotic resistance every year. If appropriate action is not taken on time, the number will increase to about 10 million by 2050. Strategies to combat antibiotic resistance worldwide and prevent the spread of drug resistant organisms have become more difficult in the age of Covid-19.

Use of antibiotics during the Covid-19 epidemic

The Covid-19 epidemic has increased the widespread use of antibiotics worldwide. Data from 191 Covid-19 patients in Wuhan, China, shows that 95% of patients have been treated with antibiotics, with only 21% of patients using antiviral drugs. Another separate study suggests that about 8% of covid-19 patients have symptoms of bacterial infections but 72% of covid-19 patients have taken antibiotics. A current survey of American doctors found antibiotics are the second most commonly used drug to treat covid-19 patients. In Michigan, USA, 56.6% of 1705 hospitalized covid-19 patients have been administered empirical antibiotics with only 3.5% of covid-19 patients having bacterial infections. The World Health Organization, on the other hand, reports that azithromycin is widely used with hydroxychloroquine, although it is yet to be recommended for use outside the Covid-19 clinical trial. Some recent studies have shown that expensive antibiotics are also being used in Bangladesh in a thoughtless way. Antibiotics can be divided into three categories according to the AWaRe (Access, Watch and Reserve) category "access group" is used for primary level infections, "watch group" is used for bacteria with high resistant, "reserve group" is used if all alternative ways fail. A study conducted by the Institute of Epidemology Disease Control and Research (IEDCR) in Bangladesh found that watch group antibiotics were used in 70% of cases, access group antibiotics in 28%, reserve group antibiotics in 0.8% cases and medicines not approved by who who were not approved by the World Health Organization. Therefore, it is clear that antibiotics are being used extensively all over the world during the Covid-19 epidemic.

Why has antibiotic resistance increased during the Covid-19 epidemic?

It is very difficult to say at what rate the Covid-19 epidemic affects antibiotic resistance. The rate of antimicrobial resistance is unclear as global use of antibiotics is low and scattered. In fact, since antibiotics are being widely used, antibiotic resistance is on the rise. Covid-19 patients are being hospitalized extensively which transmits and transfers many of the drug resistant diseases they get

from their hospitals. This increases secondary infections caused by bacteria and antibiotics are used for treatment. It has already been stated that the use of antibiotics is one of the reasons for the occurrence of antibiotic resistance. For example, 250 million antibiotic prescriptions are written every year in the United States. Antibiotics do not fully metabolize the human body and 30-90% are released out of the body unchanged. Again, traditional waste treatment management removes 20-80% of pharmaceuticals and their metabolites. Therefore, antibiotics are released directly or indirectly into the environment. On the other hand, during the Covid-19 epidemic, disinfectants are being used extensively in the environment and for personal needs. As of March 2020, at least 2,000 tonnes of disinfectant was used in Wuhan, China. The presence of antibiotics and disinfectants in surface water has been detected up to 1mg/litre which is a matter of great concern. Thus, high use and abuse are increasing the density of antibiotics and disinfectants in the environment, which threatens health risks and environmental balance in human life and causes antibiotic resistance.

How antibiotics can be used properly during the Covid-19 Mahamari:

In order to prevent antibiotic resistance, inconsistent and unnecessary use of antibiotics has to be eliminated. Antibiotics have to be applied according to international or local guidelines. Doctors should have a very good understanding of respiratory germs such as knowing the difference between viral or bacterial germs in the respiratory system. Antibiotics should be applied only if a disease is caused by viruses or bacteria and is caused only by bacteria. Antibiotics should be applied based on the results of culture and sensitivity tests with patient samples. Multidrug resistant germs such as ventilator-related germs, catheter-related germs are found in critical covid-19 patients, so every hospital should have adequate preventive measures. Creating new antibiotics, providing and researching antibiotics alternativeto non-antibiotic drugs to reduce the use of antibiotics. In addition, antibiotic awareness week should be observed every year to create a wide awareness among the general public to prevent antibiotic resistance worldwide and to prevent infection and spread of drug-resistant diseases.

The Global Antibiotic Research and Development Partnership (GARDP) recommends the following five issues to combat global antibiotic resistance:

1. Urgent detection of drug resistant germs.

2. To invest heavily in the medical sector as a counter-measure to combat the future epidemic of infectious diseases.

3. Ensuring all types of medical facilities, medicines, vaccines, diagnostic kits adequately for all in the epidemic.

4. Ensuring the same health structure around the world and expanding global cooperation.

5. Equally participate in global response to the elimination of antibiotic resistance to low and middle income countries.

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