KARACHI: An unprecedented increase in the use of antibiotics, especially Azithromycin has been recorded in Pakistan during the pandemic where most of the COVID-19 patients are being prescribed the antibacterial medicine although they have ‘absolutely no role’ in treatment of viral infections like COVID-19, health officials and infectious diseases experts Wednesday said.

They claimed that use of some antibiotics and corticosteroids including prednisone and dexamethasone has increased between 300 to 500 percent in the country during last one year, mostly due to self-medication and their over-the-counter availability but warned their misuse could lead to serious health issues including diluting the antimicrobial resistance (AMR) leading to emergence of lethal fungal infections like mucormycosis or black fungus. “There is widespread misuse of antibacterial medications (eg azithromycin) and others - with no role in treating essentially a viral infection. The national guidelines are very clear on this but unfortunately that has not stopped this practice," Special Assistant to the Prime Minister (SAPM) Dr. Faisal Sultan said when asked if there was any benefit or role of prescribing antibiotics, especially Azithromycin to COVID-19 patients. Dr Sultan, who is himself an infectious diseases expert, deplored that even some specialists are prescribing medicines which don’t have a scientific basis or a globally accepted guideline to support their usage.

Eminent pulmonologist Prof. Sohail Akhtar, who has treated hundreds of Covid-19 patients, lamented that azithromycin was not only being prescribed by GPs and consultants but even patients are taking the drug on their own as soon as they test positive for the Covid-19 and demanded the authorities to take measures for curbing its use and other antibiotics. “Government should come forward and take measures to prevent the use of antibiotics against viral infections and curb self-medication. Leading healthcare professionals and experts should also repeatedly warn people against antibiotics’ use in Covid-19 and other viral infections”, Prof. Sohail, serving at Indus Health Network, suggested.

Another eminent infectious diseases expert associated with Indus Hospital Karachi, Dr Naseem Salahuddin believed that prescribing antibiotics of any kind in a minor case of Covid-19 or any viral infection is malpractice. “This is clearly leading to antibiotic resistance in the community and we are having difficulty treating serious bacterial infections with antibiotics. Patients are dying because unscrupulous or ill informed practitioners are prescribing antibiotics irrationally and there is a rising resistance of even common bacteria to commonly used antibiotics. This message should go out loud and clear”, she added.

Another infectious disease expert and consultant at Aga Khan University Hospital (AKUH) Dr Faisal Mehmood also made it clear that there was no role of azithromycin or any other antibiotic in the treatment of Covid-19 and warned their use was causing more harm than any good. “We have no idea why antibiotics are so widely being prescribed for Covid-19 but most probably, lack of knowledge on how to use antibiotics could be one of the causes. Not just general physicians (GPs) but even consultants are prescribing antibiotics, especially azithromycin for the management of COVID-19,” he observed. When asked if there were any specific national guidelines against azithromycin and other antibiotics for the management of COVID-19, he said indeed there were guidelines specifically barring (antibiotics) use in most of cases.

While the sale of all kinds of antibiotics, corticosteroids and other prescription is continuing unabated in the country, if and when a trained pharmacist tries to prevent people from self-medication or advises to take a second opinion, he or she is often cursed by the customers. “I and other pharmacists at different branches of Ehad Medical Center in Karachi are sometimes criticized for preventing self-medication or advising against use antibiotics for the treatment of Covid-19. We don’t sell medicines without prescription and offer telemedicine consultation with a pulmonologist or infectious diseases experts in case of suspected or even confirmed cases of Covid-19,” says Umaima Muzammil, a pharmacist associated with Ehad Medical Center in Karachi. The President of Pakistan Society of Health System Pharmacists (PSHP) Abdul Latif Shaikh said Drug Regulatory Authority (DRAP) should come forward and issue ‘black-box or special cautionary warning’ against antibiotics, especially azithromycin for Covid-19, whose use has increased unprecedentedly during the pandemic.

An official of the DRAP said they have already issued an advisory against the use of Chloroquine, Hydroxychloroquine and Azithromycin for the treatment of Covid-19. “But if healthcare professionals come up with a recommendation and advisory in this regard, they and DRAP can jointly issue guidelines which would be helpful for patients in Pakistan,” he added.