COVID-19 likely contributed to 216.4 million excess doses of antibiotics for adults, suggesting that the drug was used by almost everyone to treat mild and moderate cases of coronavirus infection in the country, claims research pointing out COVID guidelines were not followed.

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The study led by researchers at the Barnes-Jewish Hospital in Missouri, US, showed a total of 16.29 billion doses of antibiotics were sold in India in 2020. Adult dose usage increased from 72.6 per cent in 2018 and 72.5 per cent in 2019 to 76.8 per cent in 2020. In addition, sales of azithromycin, used for treating typhoid fever, non-typhoidal Salmonella and traveller's diarrhoea, for adults in India increased from 4 per cent in 2018 and 4.5 per cent in 2019 to 5.9 per cent in 2020.

The study, published in the journal PLOS Medicine, also showed notable increases in the sales of doxycycline and faropenem, two antibiotics commonly used to treat respiratory infections. "Antibiotic resistance is one of the greatest threats to global public health. Overuse of antibiotics lessens their ability to effectively treat minor injuries and common infections such as pneumonia, which means that these conditions can become serious and deadly. Bacteria that have become resistant to antibiotics don't have boundaries.

"They can spread to any person in any country," said infectious diseases specialist Sumanth Gandra, Associate Professor of medicine and an associate hospital epidemiologist at the Barnes-Jewish Hospital. "Our results indicate that almost everybody who was diagnosed with COVID-19 received an antibiotic in India," he added. On the other hand, in high-income countries such as the US, UK and Canada, overall antibiotic use plunged in 2020, even during COVID-19 peaks, revealed the study.

"This is because physicians in high-income countries generally did not prescribe antibiotics for mild and moderate COVID-19 cases. The uptick in India indicates that COVID-19 guidelines were not followed," Gandra said. In India, an unregulated private sector accounts for 75 per cent of healthcare and 90 per cent of antibiotic sales, allowing for antibiotic overprescription. Antibiotics should only be given to patients who develop secondary bacterial illnesses, but Gandra said that "this was not the case, indicating the need for policy changes in India, especially in light of the current crisis and the possibility of a devastating third wave".