Use of antibiotics rampant, careless

A study has revealed that costly antibiotics are being prescribed injudiciously for treating Covid patients at hospitals, which could lessen effectiveness of the lifesaving drugs in killing bacteria.

Such irrational use of antibiotics is also putting unnecessary financial burden on patients, said researchers involved in the study.

The Institute of Epidemiology, Disease Control and Research (IEDCR) and the American Society for Microbiology (ASM) jointly conducted the study at five Covid and five non-Covid hospitals in the capital, Chattogram, Rajshahi and Sylhet. Of the hospitals, five are state-run and five private.

Data was collected from May 1 to July 30 this year for the study titled "Antibiotic Usage and Antimicrobial Resistance in Tertiary Care Hospitals of Bangladesh".

Bacteria-fighting drugs known as antibiotics have been helping control and destroy many of the harmful organisms that can make one sick.

But in recent times, overuse and misuse of antibiotics led some strains of bacteria to make small changes in their DNA and become antibiotic-resistant "superbugs", according to health experts.

This happens mainly due to injudicious use of antibiotic drugs, they said.

As per the AWaRe (Access, Watch and Reserve) classification, antibiotics are classified into three groups -- "Access Group" used for a wide range of primary level infection, "Watch Group" used against higher resistance bacteria, and "Reserve Group" only to be used when all alternatives fail.

AWaRe classification is a method to classify all antibiotics adopted by the World Health Organization in 2019.

The IEDCR study found that physicians prescribed the Watch Group drugs in around 70 percent cases, followed by Access Group drugs (28 percent), Reserve Group drugs (0.8 percent), and drugs not recommended by the WHO (0.4 percent).

"Physicians should be cautious while using Watch Group antibiotics as these drugs have the potential to give rise to resistant bacteria," said Dr Zakir Hossain Habib, head of microbiology and principal scientific officer at the IEDCR, who led the study.

The study listed top 10 antibiotics based on their use among patients at the Covid-19 wards and ICUs.

It showed Ceftriaxone was physicians' first choice for majority of the patients at four of the five Covid-dedicated hospitals.

For example, Ceftriaxone was the first choice for treating 62.8 percent of the Covid patients at Bangladesh Institute of Tropical and Infectious Diseases in Chattogram, followed by a combination of Amoxicillin and Clavulanic Acid (24.8 percent).

Similarly, Ceftriaxone was the doctors' top choice for treating 55.8 percent of the patients at Rajshahi Medical College Hospital, 53.6 percent at Shahid Shamsuddin Hospital in Sylhet, 30.7 percent at Chattogram Medical College Hospital and 27.9 percent at Uttara Adhunik Medical College Hospital in the capital.

According to a 2017 IEDCR study, the widely-prescribed ceftriaxone was ineffective in combating E-coli, proteus spp, non-typhoidal salmonella and Acinetobacter complex and other bacteria in many cases.

The latest study said Meropenem -- a Watch Group drug -- was also among the top 10 antibiotics used at these five hospitals. This was widely used for the patients in intensive care units.

"Covid-19 is a viral infection and antibiotics are not effective in treating it. Antibiotics should not be used unless there is possibility of secondary bacterial infection… Physicians should be judicious in selecting antibiotics," Dr Zakir told this newspaper yesterday.

"This [use of antibiotics] also puts unnecessary financial burdens on patients."

Ceftriaxone is a costly and overrated drug. It should not be used without proper judgement, he observed.

Voicing concern over widespread use of very effective antibiotic Meropenem for Covid patients, he said doctors should be more careful about using this drug and try to avoid it whenever possible.

According to experts, Culture and Sensitivity Test of a patient's specimen is a mechanism to see what kind of medicine, such as an antibiotic, will work best to treat a particular disease or infection.

Worryingly, this practice was found in case of drug selection for just 5.97 percent at private hospitals and only 3.44 percent at public hospitals.

Based on the study, researchers recommended prescribing antibiotics based on the results of Culture and Sensitivity Test.

They also said ceftriaxone should be used judiciously.