CLEVELAND — As an infectious disease specialist, I’ve seen enough COVID-19 to last a lifetime. And although we’re approaching the fifth anniversary of Cleveland’s first cases, it feels somehow like it was just yesterday. That’s not unexpected. The virus still affects us in insidious ways.
The World Health Organization, for example, recently reported that while only 8% of hospitalized patients with COVID-19 also had a bacterial infection requiring antibiotics, 75% of patients with COVID-19 around the world received them, anyway, “just in case.” The result is antimicrobial resistance on a massive scale. In simple terms, drugs we’ve always used against bacterial infections could become dramatically less effective.
To be clear, antibiotics don’t treat viral infections like COVID-19, but the COVID-19 patients who nonetheless still were treated with antibiotics aren’t unique. Health care offices and facilities across the United States fit a similar pattern, with many distributing antibiotics to patients complaining of colds and flu – also viral illnesses where antibiotics won’t help.
You may wonder – what’s the harm? Isn’t an antibiotic an “insurance policy” just in case the condition is caused by bacteria? Am I supposed to just wait for bacterial cultures to come back from the lab for an answer?
In a word, yes. When you use antibiotics improperly – either for viral illnesses or by not finishing the entire prescription for a bacterial illness – you contribute to the growing global problem of antimicrobial resistance. It may seem like one individual can’t impact an issue this large. But it’s millions of individual decisions causing the crisis. In the United States, more than 2.8 million antimicrobial-resistant infections occur yearly, and more than 35,000 people die as a result. Plus, practically speaking, taking an antibiotic for a viral infection won’t cure it and won’t prevent others from getting sick.
Consider how antibiotic resistance occurs: When you take an antibiotic for a viral infection, it attacks the bacteria in your body. But it’s a misdirected campaign – these are beneficial bacteria or those not causing disease. The bacteria surviving the onslaught pass on antimicrobial resistance to other bacteria – growing their ranks. The result? More potentially harmful bacteria taking the place of harmless ones. Now imagine this happening millions of times. According to the U.S. Centers for Disease Control and Prevention, at least 28% of antibiotics prescribed in outpatient settings aren’t needed.
Dr. Leila Hojat is an infectious disease specialist and director of Antibiotic Stewardship at University Hospitals Cleveland Medical Center.Courtesy of University Hospitals Cleveland Medical Center
This problem is so consequential that patients and health care providers must work together to solve it. For our part, we’re working at my institution to better manage how our hospitals use antibiotics. We recently won national recognition for efforts to reduce overuse of an anti-MRSA agent and to free up use of penicillin by more accurately identifying patients who are truly allergic to it.
But we need everyone’s help to safeguard our antibiotics so we can rely on them into the future. When you visit your health care provider, say that you don’t expect an antibiotic if it’s not needed. If they don’t bring it up, bring it up yourself. Say that you want to hear about both the risks and benefits of antibiotics, and you will trust them if they tell you an antibiotic isn’t needed.
Later this month, from Nov. 18-24, we will celebrate Antibiotic Awareness Week. During that time, please consider what antibiotics — true “wonder drugs” — make possible: Everything from joint replacement to organ transplant would be unthinkable without them. When we’re in a weakened state due to antimicrobial-resistant bacteria, we’re simply at greater risk. Let’s all work together to make sure that doesn’t happen.
Dr. Leila Hojat, MD, is an infectious disease specialist and director of Antibiotic Stewardship at University Hospitals Cleveland Medical Center. Her clinical interests include novel antimicrobial agents, rapid diagnostics and health disparities.
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