Antibiotic Prescribing Patterns at COVID-19 Dedicated Wards in Bangladesh: A Single Center Point-Prevalence Survey

There is a clear deficiency in antimicrobial usage data and ongoing stewardship programs both in government and private health care facilities in Bangladesh. As evidences are mounting regarding irrational and often unnecessary use of antibiotics during COVID-19 pandemic, a point prevalence survey (PPS) was conducted across COVID-19 dedicated wards in Dhaka Medical College and Hospital (DMCH). Antibiotic usage data were collected from 193 patients at different COVID-19 dedicated wards at DMCH between 21 May, 2020 and 10 June, 2020. Comparisons in antibiotic usage were made between different groups using Pearson chi-square and Fisher exact test. Factors associated with multiple antibiotic prescription were evaluated using binary logistic regression model. On survey date all (100%) patients were receiving at least one antibiotic with 133 patients (68.91%) receiving multiple antibiotics. Overall, patients presenting with severe disease received more antibiotics on average. Third generation cephalosporin ceftriaxone (53.8%), meropenem (40.9%), moxifloxacin (29.5%) and doxycycline (25.4%) were the four most prescribed antibiotics among survey patients. Among comorbidities diabetes mellitus (DM) was independently associated with increased antibiotic prescribing. Abnormal C-reactive protein (CRP) and serum d-dimer were linked with higher odds of antibiotic prescribing among survey patients. Overall, prevalence of antibiotic prescribing in COVID-19 patients at DMCH was very high. This could be attributed to a lack of clear treatment protocol against COVID-19 till date as well as lack of modern laboratory facilities to support judicial antibiotic prescribing in Bangladesh. A well-functioning antibiotic stewardship program in Bangladesh is required to prevent an impending health crisis.

Antimicrobial Resistance, Evidences on Irrational Anti-microbial Prescribing and Consumption during COVID-19 Pandemic and Possible Mitigation Strategies: A Bangladesh Perspective

There are evidences that show increased antimicrobial consumption among COVID-19 patients. This has increased the burden on worsening situation of antimicrobial resistance (AMR) throughout the world. Bangladesh, one of the countries with highest numbers of COVID-19 cases, without effective regulation of antimicrobial prescription may suffer in future with study results showing a significant proportion of participants taking antimicrobial without proper indication and prescription from physicians. Suggested mitigation strategies include - strict regulation of over the counter (OTC) antimicrobial prescription, testing biochemical marker such as procalcitonin prior to initiation of antimicrobial therapy, introduction of color coded and tightly sealed bottled antimicrobial drugs, massive campaigning on social media, effective utilization of telemedicine and finally, raising awareness among physicians and patients regarding judicial use of antimicrobial.