The prescription of antibiotics defied the Covid protocol

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Critically ill patients who overwhelmed hospitals during the first wave of Covid-19 in April last year and the second wave in July-August this year presented telltale symptoms of Covid-19 – high fevers and pulmonary infection.

With few treatment options, doctors have turned to their weapon of choice, prescribing from a wide array of antibiotics. Now, medical research shows that up to 80% of prescribed antibiotics were unnecessary and did not follow the national coronavirus treatment protocol.

Doctors at Mugda Medical College Hospital, who conducted the research, said antibiotics made up 70% of drugs for hospital patients. Medication use was 80-100% for ICU patients.

Defending the drugs, Prof Sayedur Rahman, vice-chair of the Bangladesh section of the Global Partnership for Antibiotic Resistance, argued that doctors were focusing on saving as many lives as they could instead. to stick firmly to the protocol.

According to research, 33% of Covid patients have taken antibiotics on their own even before being admitted to hospital.

Researchers warn of massive antibiotic resistance, which they call another Covid-like pandemic, if antibiotic use is not reduced. They stressed the need to ensure the proper use of drugs before a third wave of Covid tears the country apart.

“More than 87% of hospital patients were prescribed one or two antibiotics. But only 7% of hospital patients needed these drugs,” Professor Rubina Yeasmin, one of the researchers and also chief, told The Business Standard. of medicine at Mugda hospital. .

But the national health ministry directive restricts the use of antibiotics only for secondary infections. According to the guideline, simple antibiotics (amoxicillin and clavulanic acid) should only be prescribed at the discretion of the consultant and if there is a strong suspicion of secondary bacterial infection.

Professor Rubina Yeasmin said doctors have been trained on Covid treatment guidelines. But there had been virtually no follow-up if they had maintained it.

Professor Ahmedul Kabir, secretary general of the Bangladesh Society of Medicine and board member of the treatment guidelines committee, agreed that doctors in most cases did not follow the protocol.

“As the disease was new and we had no idea, many doctors were prescribing antibiotics unnecessarily,” said Prof Ahmedul Kabir.

In June last year, the World Health Organization (WHO) warned that the increased use of antibiotics to fight the pandemic would bolster bacterial resistance and ultimately lead to more deaths during the crisis and beyond. .

The lab is also to blame

During the first and second waves, doctors prescribed the drugs as soon as patients’ lungs became infected, as most hospitals do not have any laboratory devices to test for bacterial infection.

Professor Rubina Yeasmin said the laboratory at her Mugda medical workstation – one of the main dedicated Covid treatment facilities in Dhaka – does not have bacterial culture tests. They did not have time to direct patients to have the test elsewhere as well.

She said the lack of testing also contributed to the over-prescribing.

Where is the policy on antibiotics?

Prof Sayedur Rahman said it was difficult to find people in Bangladesh who had not taken the antibiotic Azithromycin in the past two years.

Echoing the WHO warning, he said antibiotic resistance was going to be the next health crisis as Bangladesh does not have a specific policy for the use of antibiotics.

Professor Rubina Yeasmin said the country needs to prepare the policy immediately and follow up so that doctors maintain it.

In addition, Professor Sayedur Rahman called for increased laboratory facilities for bacterial culture testing. He also insisted on the need for a mass awareness campaign.

Professor Ahmedul Kabir said a national level policy for the use of antibiotics was being formulated.


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