Antimicrobial stewardship involves appropriate prescription and optimized use of antimicrobials. The July issue of the Bulletin of the World Health Organization (WHO) features an editorial arguing that antimicrobial stewardship activities should be integrated into the COVID-19 pandemic response across the broader health system.
 
It argues that five measures should be advanced: 1 - Increase clinical competence among health workers treating COVID-19 patients through targeted training. 2 - Ensure the continuity of essential health services and regular supply of quality assured and affordable antimicrobials including antiretroviral and tuberculosis drugs, and vaccines. 3 - Reduce the turnaround time of COVID-19 testing by improving testing methods and expanding testing facilities, to reduce the urge to start antibiotics. 4 - Exercise maximum caution in the use of biocides for environmental and personal disinfection and prioritize biocidal agents without or with a low selection pressure for antibiotic resistance. 5 - Address gaps in research to ensure that antimicrobial stewardship activities become an integral part of the pandemic response and beyond.     
 
The editorial also notes that the latest update of WHO’s interim guidance on the clinical management of COVID-19 does not recommend antibiotic therapy or prophylaxis for patients with mild or moderate COVID-19 unless signs and symptoms of a bacterial infection exist. The use of empiric antibiotic treatment for patients with suspected or confirmed severe COVID-19, based on clinical judgement considering patient host factors and local epidemiology, along with daily assessments for de-escalation, is recommended.
 
The full editorial Tackling antimicrobial resistance in the COVID-19 pandemic is available here: https://www.who.int/bulletin/volumes/98/7/20-268573.pdf.
 
The WHO will need to increase its support to developing countries to implement context specific measures for antimicrobial stewardship as part of the response to the COVID-19 pandemic, bearing in mind the multitude of challenges those countries face. The WHO also needs to lead the global effort to support timely and affordable access to treatments and vaccines when developed, especially for developing countries, and provide guidance at country level on access strategies.  
 

Author: Viviana Muñoz Tellez is Coordinator of the Health, Intellectual Property and Biodiversity Programme (HIPB) of the South Centre.