February 13, 2023
As COVID-19 cases increased globally, so did antibiotic sales.
One Health Trust and collaborators analyzed data on four broad-spectrum oral antibiotic sales in 71 countries during the COVID-19 pandemic. While sales fell sharply in March 2020, they recovered to near pre-pandemic levels by May 2022. Antibiotics were prescribed to 75 percent of COVID-19 patients despite bacterial coinfection rates averaging less than 10 percent. A 10 percent rise in monthly COVID-19 cases was linked to 0.3 percent higher sales of the studied antibiotics combined per 1,000 individuals. The pandemic’s overall impact on rising aggregate broad-spectrum antibiotic use has been small, perhaps due to fewer non-COVID illnesses resulting from COVID-19 mitigation measures. Antibiotics should not be used in COVID-19 cases unless necessary to prevent COVID-19 from becoming another influenza-like illness for which antibiotics are routinely and inappropriately prescribed. [eClinicalMedicine]
The history of colistin resistance through a One Health lens.
Resistance to colistin, an antibiotic often viewed as a last-resort therapy against multi-drug-resistant Gram-negative bacteria (GNB), has emerged in Enterobacteriaceae species. One Health Trust and collaborators traced the history of colistin resistance and analyzed the impact of regulatory policies on colistin use on the prevalence of resistant E. coli using a One Health approach. Since the discovery of mcr-1, a plasmid-mediated colistin resistance gene, regulations, and policies have been created to maintain some of colistin’s efficacy. These measures have resulted in a steep decline in colistin production and the prevalence of colistin-resistant E. coli between 2016 and 2019. [International Journal of Antimicrobial Agents]
Global antimicrobial use in food animals is predicted to rise.
Researchers assessed antimicrobial use (AMU) in food-producing animals worldwide in 2020 and predicted AMU rates for 2030. Using government reports and previously published data, the global usage of veterinary antimicrobials was estimated to be 99,502 tonnes in 2020, with an expected eight percent increase to 107,472 tonnes by 2030. Additionally, AMU in Africa was estimated to be twice the number reported by WOAH, and AMU in Asia was 50 percent greater than reported rates. Despite ongoing efforts to tackle veterinary antimicrobial use, many nations — especially low- and middle-income countries — do not publish country-level AMU data, forcing scientists to rely on modeling estimates to inform antimicrobial stewardship policies. [PLOS Global Public Health]
Introducing a novel tuberculosis vaccine in LMICs would be cost-effective.
Researchers evaluated the future costs, cost savings, and cost-effectiveness of introducing novel in-development tuberculosis (TB) vaccines in low- and middle-income countries (LMICs) for various scenarios and delivery methods. Overall, TB vaccine introduction in LMICs was predicted to be beneficial to health and the economy between 2028 and 2050, more so for an adult or adolescent vaccine than an infant vaccine. Analysis revealed that the vaccine would be cost-effective in most LMICs, including those with a high TB burden. [PLOS Medicine]
Antidepressants may promote antibiotic resistance.
New research has illuminated the potential role that antidepressants play in the development of antibiotic resistance. By triggering an “SOS” response in bacteria, antidepressants promote cellular defense mechanisms that allow bacteria to survive subsequent antibiotic treatment. One study showed that a sample of E. coli became resistant to several antibiotics following exposure to the antidepressant fluoxetine. Exposure to another antidepressant, sertraline, promoted the transfer of genes between individual bacteria, possibly leading to the transmission of resistance-conferring genes within a population. [Nature]
Discrimination in global health conferences.
Health professionals and practitioners from low- and middle-income countries (LMICs) faced frequent discrimination in 2022 while trying to enter countries where global health conferences were held. From rejected visa applications to harassment at border controls and immigration counters, experts, especially those from countries in Africa, were blocked from attending important conferences and contributing to global health conversations. While some have boycotted conferences in solidarity, many professionals call for hosting more conferences in LMICs to break down the systemic barriers that prevent equitable attendance and provision of crucial global health knowledge. [BMJ]
Research and investment gaps in fighting Sudan ebolavirus outbreak in Uganda.
An Ebola outbreak caused by the Sudan ebolavirus (SUDV) was detected in Uganda in September 2022. This outbreak has mostly afflicted gold miners, who are often mobile and can spread the disease to other communities and bordering countries, such as the Democratic Republic of Congo. However, diagnosing SUDV poses a challenge to the Ugandan healthcare system – its symptoms resemble those of common communicable diseases. While three vaccine candidates have been cleared for testing in clinical trials in Uganda, no approved vaccine or therapeutics targeting SUDV exist. Research and surveillance data around SUDV are scarce and require further investment. [BMJ Global Health]
No universal tracking system for pandemic preparedness and response funds.
The Global Burden of Disease 2021 Health Financing Collaborator Network’s study emphasizes the challenges of tracking financial data associated with pandemic preparedness and response. Due to a lack of a universal reporting mechanism, funding from national governments and non-governmental organizations is not closely monitored. Current calculations show that $124 billion would be required over the next five years for every country to develop and sustain sufficient preparation and responses to future pandemics, according to International Health Regulations. [The Lancet Global Health]
Antibiotic identification and use skills moderate antibiotic-related behaviors among parents in China.
A cross-sectional study in China between June 2017 and April 2018 assessed the moderating effect of parental identification of antibiotics on the association between parental skills related to antibiotic use and inappropriate antibiotic use in children. Parents with medium (OR: 0.45) or high (OR: 0.15) levels of skill for both antibiotic use and identification were less likely to self-medicate their children than those with a low level of both skills. Parents with a medium or high level of skill for antibiotic use were less likely to ask their children’s doctor for antibiotic prescriptions than those with a low level of antibiotic use-related skill. For parents with equally low skills for antibiotic use, a higher level of skills for antibiotic identification resulted in a greater likelihood of self-medicating with antibiotics and asking doctors for antibiotic prescriptions when seeking care. [BMC Public Health]
Image from Canva.