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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

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Dear Editor

Antimicrobial resistance has become a global concern over the course of the years. Unfortunately, it is becoming a major threat during the COVID-19 pandemic. Considering the prevailing conditions, the World Health Organization has provided clear antibiotic stewardship principles about the use of antibiotics. WHO states that antibiotics cannot kill viruses, they can only be used to treat bacterial super-infections in COVID-19 patients.[1]

In third world countries like Pakistan antimicrobial resistance is a matter of grave concern because the literacy rate is quite low. In a country where a major chunk of the population cannot read or write, the term “antibiotic resistance” seems quite alien.[2] So, educating the masses about antimicrobial resistance is no doubt challenging yet the need of the hour. This lack of awareness has led to self-medication and extensive use of unprescribed antibiotics during the pandemic.[3] The social stigma associated with the disease has also heightened in Pakistan which is adding fuel to the ‘fire of resistance’. People associate the disease with particular ethnic and religious groups. Misinformation and conspiracy theories also play a role in weakening the status of corona virus as a real threat to mankind.[4] Thus, individuals tend to hide their symptoms and refuse to get tested. They resort to self-dosing of broad-spectrum antibiotics even for treating mild symptoms oblivious of the fact that this is rendering bacteria more resistant.

Recently, EU JAMRAI held an antibiotic resistance symbol making competition in order to educate people and highlight the issue globally.[5] Pakistan and other third world countries should also focus on carrying out such awareness activities to call attention to this serious matter. Public health care experts should unite to bring clarity on this issue and make the laymen aware of misuse of antibiotics and future risks that it can impose. Keeping in view the low literacy levels, this can be done by explaining such scientific problems in native languages and simpler terms. A psychological study shows that people tend to be more responsive towards concepts explained in their native language.[6] th importance of expert medical advice should be promoted. Self-medication should be highly discouraged particularly for COVID-19 and generally for all kinds of diseases. While the masses are being educated about hand hygiene and social distancing, it is high time that government and health care professionals join hands to help communities determine the severity of antimicrobial resistance too. If this situation is not handled diligently, we might win the battle of COVID-19 but we will be left unarmed against resistant pathogens in the years to come.

1. Getahun H, Smith I, Trivedi K, Paulin S, Balkhy HH. Tackling antimicrobial resistance in the COVID-19 pandemic. Bull World Health Organ. 2020;98(7):442-442A. doi:10.2471/BLT.20.268573
2. Akhund R, Jamshed F, Jaffry HA, Hanif H, Fareed S. Knowledge and Attitude of General Pakistani Population Towards Antibiotic Resistance. Cureus. 2019;11(3). doi:10.7759/cureus.4266
3. Rather IA, Kim BC, Bajpai VK, Park YH. Self-medication and antibiotic resistance: Crisis, current challenges, and prevention. Saudi J Biol Sci. 2017;24(4):808-812. doi:10.1016/j.sjbs.2017.01.004
4. How denial and conspiracy theories fuel coronavirus crisis in Pakistan | Asia| An in-depth look at news from across the continent | DW | 23.06.2020. Accessed July 16, 2020.
5. Antibiotic Resistance Symbol Contest - JAMRAI. Accessed July 16, 2020.
6. Caldwell-Harris CL. Emotionality differences between a native and foreign language: Theoretical implications. Front Psychol. 2014;5(SEP). doi:10.3389/fpsyg.2014.01055

Competing interests: No competing interests

17 July 2020
Summan Zahra
King Edward Medical University
Lahore, Pakistan