Intended for healthcare professionals


How covid-19 is accelerating the threat of antimicrobial resistance

BMJ 2020; 369 doi: (Published 18 May 2020) Cite this as: BMJ 2020;369:m1983

Read our latest coverage of the coronavirus pandemic

  1. Jeremy Hsu, freelance journalist
  1. New York, USA
  1. jmichael.hsu{at}

Healthcare responses to the novel coronavirus may be hastening another long looming public health threat, writes Jeremy Hsu

The global threat of antimicrobial resistant bacteria and other superbugs is worsening as many patients admitted to hospital with covid-19 receive antibiotics to keep secondary bacterial infections in check.

“Since the emergence of covid-19, collected data have shown an increase in antibiotic use, even though most of the initial illnesses being treated have been from covid-19 viral infection,” says Dawn Sievert, senior science advisor for antibiotic resistance at the US Centers for Disease Control and Prevention (CDC). “The resulting increased exposure to healthcare settings and invasive procedures, along with expanded antibiotic use, amplifies the opportunity for resistant pathogens to emerge and spread.”

Much remains unknown about how the pandemic is directly impacting overall levels of antimicrobial resistance (AMR), but a review of data from covid-19 cases, mostly in Asia, found that more than 70% of patients received antimicrobial treatment despite less than 10%, on average, having bacterial or fungal coinfections.1 The same study also found frequent use of broad spectrum antibiotics—designed to kill a wide range of bacteria—that can spur AMR through overuse. Such findings give weight to researchers’ concerns that increased antibiotic use during the pandemic could increase the long term threat of AMR.

Recommended use

The World Health Organization discourages the use of antibiotics for mild cases of covid-19 while recommending antibiotic use for severe covid-19 cases at increased risk of secondary bacterial infections and death. Hanan Balkhy, assistant director general for AMR at WHO, told The BMJ that early data on patients with covid-19 suggest only a minority have bacterial coinfections. “WHO continues to be concerned by the inappropriate use of antibiotics, particularly among patients with mild covid-19,” Balkhy says.

One factor likely …

View Full Text