Use of antimicrobials during the COVID-19 pandemic: a qualitative study among stakeholders in Nepal

Abstract

AbstractIntroductionThe COVID-19 pandemic was a major public health threat and posed tremendous pressure to develop a cure for it. Apart from ongoing efforts in developing vaccines, a lot of empirical treatments were recommended, that may have expedited the use of antimicrobials. The main objective of this study was to explore if and how the pandemic posed pressure on antimicrobials in Nepal using semi-structured interviews (SSIs) among patients, clinicians and drug dispensers.MethodsA total of 30 stakeholders (10 each among clinicians, dispensers and COVID-19 patients) were identified purposively and were approached for SSIs. Clinicians and dispensers working in three tertiary hospitals in Kathmandu were first approached and were asked for their support to reach out to COVID-19 patients who were on follow-up at their out-patient department. SSIs were audio recorded, translated and transcribed into English, and were analyzed for thematic synthesis.ResultsOver-the-counter (OTC) uses of antibiotics were widespread during the pandemic, and were mostly rooted to patients’ attempts to halt the potential severity due to respiratory like illnesses, and the fear of being identified as a COVID-19 patients. Being identified as a COVID-19 patient was feared because of the stigmatization and social isolation. Patients who visited the drug shops and physicians were reported to make demands on specific medicines including antibiotics that may have added pressure among physicians and dispensers. Clinicians reported a degree of uncertainty related to treatment and that may have added pressure to prescribe antimicrobials. All stakeholders, although mostly patients and dispensers with limited understanding of what constitutes antimicrobials and the mechanisms underpinning it reported that the pressure during the pandemic may have added to the adversities such as antimicrobials resistance.ConclusionsCOVID-19 added a pressure to prescribe, dispense and overuse antimicrobials and may have accentuated the pre-existing OTC use of antimicrobials. Future pandemics including infectious disease outbreaks are major public health incidents that warrant a special caution on inappropriate pressure on antimicrobials. Strict policies related to the use of antimicrobials are urgent to redress their use during normal and pandemic situations.