The ongoing Covid19 pandemic, which has resulted in almost 4,00,000 deaths in India so far, has also led to a surge in sales of antibiotics during the first wave, according to a new study. Experts are worried this could trigger another public health crisis: antimicrobial resistance (AMR).

Published in PLOS Medicine, the study found 16.29 billion doses of antibiotics were sold in India last year — its usage among the adult population increasing from 72.5% in 2018 to 76.8% in 2020.

Researchers noted the drugs were being used to treat mild-to-moderate cases of Covid19 — despite ample research noting antibiotics are effective only against bacterial infections, and not viral ones like Covid19. “Antibiotics should only be given to patients who develop secondary bacterial illnesses,” Dr. Sumanth Gandra, an epidemiologist and associate professor of medicine at the Barnes-Jewish Hospital in the U.S., who was involved in the study, said in a statement.

However, not only were patients prescribed antibiotics during the pandemic due to a lack of clarity on how to treat Covid19, but people also self-medicated with the drugs, according to Dr. N.K. Ganguly, former director-general of the Indian Council of Medical Research (ICMR).

Unfortunately, the indiscriminate use of antibiotics isn’t just ineffective and harmless — it can increase the risk of drug-resistant bacterial infections in the population.

“Antibiotic resistance is one of the greatest threats to global public health,” Gandra noted, explaining that “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.”

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The World Health Organization (WHO) has already declared AMR among the 10 biggest threats to global public health. “Without effective antimicrobials, the success of modern medicine in treating infections, including during major surgery and cancer chemotherapy, would be at increased risk,” the WHO stated.

According to Gandra, India is the “largest consumer of antibiotics in the world” and a “poster child for antibiotic misuse in low- and middle-income countries.”

At present, India contributes to one-fourth of the global burden of multidrug-resistant tuberculosis, and figures among countries where drug-resistant diphtheria is evolving. In 2019, a study also found newborns in India dying of antibiotic‑resistant infections.

The researchers pointed out the reasons: private healthcare in India is largely unregulated, coupled with the economic disadvantages of a greater part of the population — leading medical professionals to often overprescribe antibiotic drugs.

“Low- and middle-income countries tend to skip diagnostic testing for respiratory illnesses because most patients cannot afford it, so they receive antibiotics under the assumption that their illness is bacterial,” Gandra stated.

Overuse of antibiotics increases the risk of drug-resistant strains of infectious bacteria developing — which doesn’t just affect India, but the world. “Bacteria that have become resistant to antibiotics don’t have boundaries. They can spread to any person in any country,” Gandra warned.