In Pursuit of COVID-19 Treatment Strategies: Are We Triggering Antimicrobial Resistance?

Coronavirus disease 2019 (COVID-19) poses substantial challenges to social life and health-care systems across the world. Because there is no specific treatment against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), repurposing of antimicrobial agents remains a mainstay in managing COVID-19 patients. In this context, the World Health Organization (WHO) has recommended preventive and precautionary measures, such as social distancing, self-isolation, hand hygiene, and lockdowns, as effective disease containment modalities during the pandemic. 1,2 Existing data demonstrates that COVID-19 is associated with secondary infections, such as pulmonary pneumonia and ventilator-associated pneumonia. 3 In the case of secondary infections, use of antimicrobials is the only treatment strategy left for physicians, especially for suspected bacterial infections. 4 The crisis of antimicrobial resistance (AMR) is becoming devastating with each passing year, which has cautioned health-care providers to be judicious with the use of antimicrobial agents. 5,6 The current COVID-19 pandemic threatens to further jeopardize the use of available antimicrobial agents as treatment strategies. Following the H1N1 influenza outbreak in 2009, several environmental microbiologists warned that the excessive use of antibiotics might lead to an increase in resistant bacterial infections, while during the current COVID-19 pandemic, many cases were treated excessively with antibiotics. 3 The majority of COVID-19 patients are either asymptomatic or may experience mild to moderate illness without bacterial infection. 7 However, uncertainty among health-care professionals about the prudent use of antibiotics among COVID-19 patients is an intimidating factor in terms of additional health-care costs, especially for countries with limited resources and poor quality of health services. 8 Unnecessary antibiotic use in viral diseases and epidemics is leading to an increased AMR and, thus, has amplified the financial burden. 9 Because AMR has already been declared as a global emergency, health-care professionals need to be careful with the use of antimicrobial agents for the treatment of secondary infections that may arise during the course of COVID-19 and other viral diseases.