"This is a big disaster." How a pandemic kills antibiotics

At the end of December, the Russian Ministry of Health has updated the Covid-19 doctors for the prevention, diagnosis and treatment of Covid-19. This is the fourteenth version, and it is strikingly different from the first. In particular, now it is recommended to prescribe antibiotics only “if there are convincing signs of bacterial infection”, while earlier they were included in the standard treatment regimen (in particular, azitromycin was widely used).

The problem of stability of bacteria to drugs of WHOs is one of the ten global threats to the health of mankind. As a result of the study, American scientists have found that resistance to antibiotics has become the main cause of death in the world. The results of the study were published in January of the Lanzet Medical Journal. More than 1.27 million people died in 2019 from bacterial infections resistant to antibiotics, almost 5 million deaths are indirectly associated with resistance to antimicrobial drugs.

The correspondent of the North. Realiy talked with doctors about how the pandemic of coronavirus influenced this problem, what contribution to Russia and how to behave a sick Covid.

Man vs bacteria

If you use antibiotics incorrectly - randomly and when there is no indication, then there is a great risk that the bacteria that the drug had to destroy will only become stronger. Resistance to antimicrobial drugs nullifies the possibility of a healthcare system: for the treatment of, it would seem, simple infections are required more and more complex and expensive drugs.

“The problem is very serious,” says candidate of medical sciences, associate professor of the First Moscow State Medical University. THEM. Sechenova Anton Rodionov . -The first antibiotics appeared in the middle of the 20th century-Penicillin, invented in 1928, began to actively use during the Second World War. In the early years, they treated almost any infections, up to the sepsis with peritonitis. Very soon, bacteria began to "adapt" to their "killers", in the medical language this is called the phenomenon of "antibiotic resistance". We have to invent more and more antibiotics, a dozen years pass - and stability is formed to them.

"The frequency of cases of resistance to antibiotics of ciprofloxacin, usually used to treat urinary tract infections, varies in the range from 8.4% to 92.9% for Escherichia coli (E. coli. - SR) and from 4.1% to 79.4% for Klebsiella pneumoniae (Klebsiella of pneumonia. - SR) , ” - gives examples of WHO .

We get new versions of old diseases that are no longer treating classical drugs

- Of those drugs that were taught me 25 years ago on pharmacology, units remained in practical use. Of course, some of the "old people" are still in the ranks, but according to very narrow indications. For example, classic penicillin can still be treated with streptococcal infections-tonsillitis, face, biseptolus treat pneumocytic pneumonia for HIV infection, streptomycin-tuberculosis, ”explains Rodionov. - But the problem is different. We get new versions of old diseases that are no longer treated with classic drugs. This is very clearly visible on the example of tuberculosis. It used to be treated for a long time with a combination of three or four drugs, and now classic schemes help less often. The problem of multi -resistant tuberculosis, or tuberculosis with wide medicinal stability, is unusually relevant in many countries of the world, including Russia.

The war between bacteria and man is constantly going on, and forces increase both sides. Bacteria gradually produce resistance, trying to turn into "superbacteria" that no well -known drugs take. The easiest way they succeed in hospitals where there is a good "training base", so nosocomial infections are the most severe. A person, in turn, invents more and more antibiotics. To prevent all known drugs from right away, medical associations agreed to use antibiotics not randomly, but “from simple to complex” and taking into account sensitivity to alleged pathogens. So the section of clinical pharmacology called "rational antibiotic therapy" was born.

The worst dream of any doctor is to get an antibioticogram in which the letter R will stand opposite each antibiotic

“In my medical youth, there was such a drug - a linesolid, the name of which was pronounced with a breath,” says Rodionov. - In order to prescribe it, it was necessary to convene an inhuman consultation with the participation of the most important professor ... 20 years have passed, and there are already a lot of cases when pathogenic microorganisms are quite resistant to linenezolide, and this drug became quite an ordinary prescription. The terrible dream of any doctor is to get an antibioticogram in which the letter R (Resistant, stable) will stand in front of each antibiotic. Alas, such cases are already there.

The realities of 2020 - a new coronavirus infection and mass self -medication - further exacerbate the problem.

"Pneumonia of pneumonia discord"

In the regions of Russia and before the Pandemia of Coronavirus, not everything was just with medicine, but now the ambulance has to wait hours, and the doctor at home with weeks. So, having determined the symptoms of a popular disease (described in detail on the Internet), the sick simply goes to the pharmacy and buys drugs according to the list. The benefit of treatment regimen is also online.

And in each such scheme there are antibiotics, more often than others - azithromycin.

“Once, back in February, Chinese experts considered that Azithromycin can help patients,” recalls the history of the appearance in the coronavirus schemes of this antibiotic, Alexei Erlich , head of the cardiosurium department of the Moscow City Clinical Hospital No. 29 named after Bauman, Doctor of Medical Sciences. -Then it turned out that it does not help very much, and in patients with heart rhythm disturbance, it can lead to disorders of the heart conductivity, life-thoroughbred arrhythmias. The routine use of azithromycin is unsafe, and I would urge people not to rush to drink it without special evidence, without special prescriptions of the doctor. And the fact that he still remained as the medicine of the first row for the treatment of coronavirus is a great trouble for Russian patients.

Azithromycin tried to use as an anti -inflammatory drug in addition to hydroxychlorokhin, reminds Rodionov: "However, clinical studies showed the failure of this idea." In general, he calls the widespread use of antibiotics in coronavirus "monstrous error."

- This is partly due to the classical idea that pneumonia (pneumonia) must be treated with antibiotics. Traditional bacterial pneumonia is necessary, but with Covid-19 lung lesions are viral in nature, but antibiotics do not act on viruses. Many colleagues argue like this: "But a viral disease can be complicated by the addition of a bacterial infection, so we prescribe antibiotics to prevent a secondary infection." And this statement is wrong. Unfortunately, the early prescription of antibiotics does not prevent the addition of a bacterial infection; Moreover, if the infection joins, then it will be more severe and will require the use of more powerful drugs of the 2-3rd line, ”says Rodionov.

And even the presence of pneumonia, changes in CT associated with coronavirus, is not an indication for the use of antibiotics

“This is a big catastrophe,” Erlich agrees. -Firstly, antibiotics have side effects. If you use them too wide, we do not achieve the goal and get more side effects than good. Secondly, the use of antibiotics in the treatment of viral-not bacterial! - Infections leads to the fact that we then meet with sustainable strains that cannot be treated. And the third - this leads to failures in pharmaceutical business, antibiotics disappear from pharmacies, and when they are actually needed, they are not. Therefore, now, when there is a coronavirus epidemic, you need to say once again that a viral infection in itself is not treated with antibiotics. Antibiotics should be used when there are undoubted signs of concomitant bacterial infection. And even the presence of pneumonia, changes in CT associated with coronavirus, is not an indication for the use of antibiotics. Pneumonia of pneumonia are different. There is ordinary pneumonia, pneumonia, which is most often caused by bacteria, and then treated with antibiotics. Viral pneumonia caused by coronavirus is not treated with antibiotics in itself. Just as flu - antibiotics are treated only by bacterial complications that are associated with the flu, the same with coronavirus. Most modern schemes in developed medicine refuse massive antibacterial therapy in favor of symptomatic therapy, especially for outpatient patients, that is, those who have not been hospitalized.

- Maybe people are simply afraid to miss the beginning of the very complications and drink antibiotics preventively?

- Antibacterial treatment is not a prevention. Almost never an antibiotic is used for prevention. When we take an antibiotic, he specifically searches for microbes in the body, which multiplied and caused the disease, then it is useful. When we only assume that there will be microbes, we let the antibiotic forward - it does not act, he has nothing to act on, there is no application point. It causes only a side effect or simply washed out of the body. Therefore, the use of antibacterial drugs out of fear of complications is also irrational.

- Given that you can’t get to the doctor, how can a person understand whether he has bacterial complications or not?

It is very important to tell people that these schemes are not written for them, they are written for doctors

- If we are talking about coronavirus, then it is not necessary to understand this yourself. There is a simple rule that is used in almost all countries with civilized medicine. People are abbrelatively treated symptomatically. Every adult knows what to do with a cold: to knock down the temperature, if it is high and you do not tolerate it, drink a lot of fluids, because the body loses fluid during high temperature, eat fully to maintain its body. If there are any medicines that need to be taken from other diseases, continue to take them. And if shortness of breath, lack of air, the impossibility of fully, to the end, without shortness of breath, finish the phrase, then you need to contact the hospital, call an ambulance or go to the hospital yourself. It’s just that you do not need to take antibiotics from fear that there may be an infection.

- However, in practice, the sick man finds a scheme on the Internet and begins to take all the medicines that are indicated there ...

- It is very important to tell people that these schemes are not written for them, they are written for doctors. These schemes can steer people who understand something in this. Just take it, open the recommendations of the Ministry of Health and read how to treat coronavirus is a disaster, it will rather lead to more harm than to benefits.

I hope that hospitals will not be in conditions of deficiency of important drugs

I hope that after all, people will be more rational, they will not take antibiotics as often as they do it now. I really hope that industry will cope and antibiotics will be enough for those people who really need them. I hope that hospitals will not be in a deficiency of important drugs and coronavirus stir will not stop us from working normally. And I really hope that there will be no developed stable, including azithromycin, strains of different bacteria, because I would not want ordinary bacterial inflammation of the lungs or any other banal infections that are treated with antibiotics, have been stable for them.

“But this is possible?”

- Theoretically, this is possible. Just with a natural course of life, decades can take this, and in a provoked situation - a couple of years.

"Drugs will stop working"

Antibiotic self -medication is unreasonable in about 99% of cases

“The boom of unjustified antibiotic therapy in 2020 will undoubtedly lead to the development of antibiotic resistance (stability), which means that some drugs will stop working in the near future,” Anton Rodionov is sure. -For example, I have great doubts that we can continue to use the usual azithromycin, say, in infections of ENT organs, where he has always been the drug of first choice. Antibiotic self -medication is unreasonable in about 99% of cases. Most often they try to treat SARS in all its manifestations, forgetting that SARS, as follows from the definition, is viral diseases. There is such a saying: "Temperature is not a sign of a lack of antibiotic in the blood." Yes, frankly, only patients cannot be scolded here, we ourselves are good. In the early 2000s, the legendary antibiotic specialist Professor L.B. Strachunsky showed that even doctors in outpatient pediatric practice antibiotics are unjustified in 90% of cases.

In Russia, many antibiotics can be bought without a prescription. And the experience of the pandemic, with massive antibiotics, is unlikely to force the authorities to decide on the ban on their over -the -counter leave, and Alexei Erlich regrets.

“In Russia, they are not able to make radical decisions that will cause discontent in people,” he said. - And this decision will cause undoubted discontent. In fact, the vast majority of serious drugs should be issued only if you have a prescription from a doctor. But the prescription vacation of drugs in itself is not the only solution. In order for this to work, there must be a normal system of outpatient doctors so that people can easily get a prescription, and not stand in line for a doctor. There should be a system that facilitates the discharge of recipes, especially if this recipe is often repeated, so that it does not need to resume their prescription every six months or once every three months to obtain drugs. Now the outpatient system in Russia is not able to easily rebuild itself. And to seriously break, we need radical solutions. And no one will make radical decisions.