Experts flag use of antibiotics in mild Covid cases

PUNE: All current treatment guidelines have stated that antibiotics should not be used in patients with non-severe Covid-19.
But experts say those with mild illness are being rampantly prescribed drugs such as azithromycin and doxycycline by doctors. Antibiotics, if used unnecessarily, can destroy good gut bacteria and disturb the body’s microbiological balance, they point out.
Similarly, antivirals like oseltamivir (Tamiflu) should not be used to treat Covid-19 as they have no effect. Tamiflu, especially, works only against influenza (flu) viruses.
Medical experts and members of the national Covid task force who TOI spoke to said treating doctors and general practitioners need to adhere to protocols to avoid misuse of antibiotics and antivirals.
The surge in mucormycosis cases is an important lesson; irrational pharmacy can do more harm than good, the experts said.
“Use of azithromycin and doxycycline is strongly discouraged by most national and international Covid treatment guidelines on an out-patient-department (OPD) basis. But their irrational and unchecked use in India is worrisome,” said infectious diseases expert Sanjay Pujari, a member of the National Task Force on Covid-19.
Covid-19 is a viral infection. Antibiotics that target bacteria should be used sparingly — only if a secondary bacterial infection has been suspected in a patient.
“Usually, bacterial infection does not develop in the first week of Covid infection. At Deenanath Mangeshkar Hospital (DMH), we do not use antibiotics in admitted Covid patients unless there is strong suspicion of an overlying bacterial infection,” said infectious diseases expert Parikshit Prayag.
Just like steroid misuse, antibiotic misuse needs to be stopped. Antimicrobial stewardship — appropriate use that improves outcomes — should be an integral part of hospitals.
“Each time we prescribe an antibiotic, we need to ask ourselves: why are we using it; is there a bacterial infection, which bacteria are likely to be involved and where is the site and source of infection,” Prayag said.
In patients with severe Covid, the decision to use antibiotics should be decided on a case-to-case basis, experts said.
"Overuse and misuse of antibiotics can lead to antibiotic resistance. Antibiotic resistance leads to more severe bacterial infections, increased risk of death, longer hospital stay and expensive treatment," Pujari said.
The antiparasitic ivermectin and antiviral favipiravir should also be used judiciously in Covid-19 patients. “The effects of these drugs over a multitude of populations have not been studied,” said internal medicine expert Vichar Nigam.