Experts say new normal could lead to antimicrobial resistance

THIRUVANANTHAPURAM: Virtual patient assessment through telemedicine has become the new normal in Covid-19 times. Meanwhile, health experts warn that without proper guidance or ground rules, the same may lead to another public health problem similar to that of a pandemic. Experts have cautioned against antimicrobial resistance (AMR) -- a condition in which bacteria/viruses and others no longer respond to medicines making infections harder to treat. According to them, AMR might occur when telemedicine leads to over-prescribing of unnecessary antibiotics as virtual assessment limits diagnostic capabilities. 

“The risk of over-prescribing can’t be overlooked. The same is the case with Covid-19 patients receiving antibiotics. It is high time that the officers overseeing the Kerala AMR Strategic Action Plan should consider this and come up with remedial measures,” said a microbiologist at a government hospital. 

Earlier, the World Health Organisation, in a document, said Covid-19 pandemic has presented potential threats that could affect antimicrobial stewardship activities and drive antimicrobial resistance. It also pointed out the scenario wherein individuals who have a mild disease without pneumonia or moderate disease with pneumonia receive antibiotics.

Besides, hospital admissions increase the risk of contracting other infections and the transmission of multi-drug-resistant organisms. This may lead to increased antimicrobial use, said a document released by the WHO. “Another potential threat is the wide use of biocidal agents for environmental and personal disinfection, including in non-health-care settings, which could also enhance the risk of cross-resistance to antibiotics,” it said.

The studies published in journals like the Lancet and Nature had also highlighted the need for taking the AMR seriously. A group of European clinicians in clinical microbiology and infection had stated antibiotic or antiviral treatment is appropriate for Covid patients who have co-infections. But those patients may be in a minority. Meanwhile, they also admit that it can be difficult to differentiate Covid-19 from bacterial pneumonia, which means that s ome patients without bacterial infections are receiving unnecessary antibiotics. 

“Considering the pandemic situation, telemedicine is being used for a limited time. The most effective way is personally examining a patient to understand the real condition. The telemedicine platform under e-Sanjeevani is being used now for initial diagnosis, follow-up and review cases, which so far turned to be of an effective one,” said Dr G S Vijayakrishnan, state secretary, Kerala Government Medical Officers’ Association.Meanwhile, he also said if the practice of virtual patient assessment continues for a long period, the threat of AMR can’t be ruled out. 

Who pointers

In certain cases, individuals who have mild disease without pneumonia receive antibiotics 

Another potential threat is the wide use of biocidal agents for personal disinfection which could also enhance the risk of cross-resistance to antibiotics