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Impact of the COVID-19 pandemic on AMR and WHO guidance

COVID-19 has impacted the AMR response. Listen to Noah Fongwen review WHO recommendations on tackling AMR during COVID-19.
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NOAH FONGWEN: In 2020, the COVID-19 pandemic interrupted the AMR programmes in many countries. In this tape, we will show the impact of COVID-19 on AMR based on the findings from two studies. And I’ll also talk about WHO guidance on tackling AMR in the COVID-19 pandemic.
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A study conducted in intensive care units in 88 countries showed that in terms of the overuse of antibiotics for COVID-19 patients, 72% of hospitalised patients received antibiotics when only 8% demonstrated bacterial or fungal co-infection. 70% of ICU patients received at least one antibiotic when only 54% had suspected or proven bacterial infection. Azithromycin was often used with hydroxychloroquine even though neither are recommended. In terms of hospital-acquired infections, increased hospital admissions increases the risks of health care-associated infections. The study also showed that the wide use of biocidal agents for environmental and personal disinfection can select for resistance and enhance cross-resistance to antibiotics, especially in gramme-negative bacteria.
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It showed that disruptions to health services during the pandemic have caused interruptions to treatments, for example, for tuberculosis and HIV, which can also lead to selection for drug resistance. It also showed that the disruption to vaccination services can increase the risk of infection, potentially leading to an overuse of antimicrobials. Azithromycin has widely been used in the management of COVID-19 patients, as it has been shown to have antibacterial, anti-inflammatory, and antiviral properties. The question is, does it really have any clinical benefit? Hinks et al.
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conducted a prospective, open-label, randomised trial, in which they enrolled 298 adults who are 18 years or older, presenting to 19 UK hospitals with clinically diagnosed, highly probable or confirmed COVID-19, and had less than 14 days of symptoms. 145 patients were randomly assigned to 500 milligrammes of azithromycin once daily for 14 days, plus standard care, and 147 were assigned to the control arm of standard care alone. The primary outcome was death or hospital admission from any cause over the 28 days from randomization. The study also aimed to determine whether azithromycin is effective in reducing hospital admission in patients with mild to moderate COVID-19.
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The conclusion, as you can see from the figure on your left, is that for patients with mild to moderate COVID-19, adding azithromycin to standard care treatment did not reduce the risk of subsequent hospital admission or death. The WHO published guidance on tackling AMR the COVID-19 pandemic. These include increased clinical competence among health care workers through training; ensure continuity of essential health services and regular supply of quality assured and affordable antimicrobials, including antiretroviral and tuberculosis drugs and vaccines; to reduce the turnaround time of COVID-19 testing; to reduce the urge to initiate antibiotics; exercise maximum caution in the use of biocides for environmental and personal disinfection to avoid unnecessary selection pressure for cross-resistance to antibiotics; to address research gaps to ensure that antimicrobial stewardship activities are integrated into the pandemic response.
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They also recommended that there should be increase in key competencies in the following areas. The ability to identify severe COVID-19 and superimposed bacterial or fungal disease, elimination of unnecessary antibiotic use, evaluation of the need for medical devices that may increase the chances of HAIs and antibiotic use, implementation of strict infection prevention and control measures. They recommended that research should be conducted on rapid and affordable diagnostic tests that differentiate between bacterial and viral respiratory tract infections; short- and long-term impact of wide use of biocides for environmental and personal disinfection, including cross-resistance to antimicrobials; and potential alternatives for sustainable environmental and personal disinfection.

In this step, Dr. Noah Fongwen shares findings from studies looking at the overuse of antibiotics for COVID-19 hospitalized patients.

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Diagnostics for AMR: Building Back Better from the COVID-19 Pandemic

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