How did antibiotics use change during the Covid-19 'pandemic'?
And what happened to the stockpiles of antibiotics Fauci said were needed in a pandemic?
After reading our ‘whodunnit’ article on pneumonia Dr David Wiseman recently sent us an email asking about antibiotics:
Senator Johnson1 asked me the other day about reports of lowered antibiotic use during the pandemic. I have probably missed those reports, but I mentioned your work on the coprevalance of various respiratory infections. He was certainly interested.
So, if it is true that antibiotic use went down this could have contributed to mortality/morbidity by failing to deal with the otherwise antibiotic sensitive components of the mixed infection.
We realised that we didn’t have a list of articles to hand covering the relevant topics:
National policy changes affecting antibiotic prescriptions and administration.
Time series statistics on changing prescription patterns in different countries.
Success stories where antibiotics were given to covid-19 patients, resulting in positive outcomes.
The role of face masks in magnifying harms.
Hence this article is a (definitely incomplete) list of the above materials and covers, examples of successful application, academic papers and statistical charts.
Antibiotics are essential in a pandemic. This view is motivated by the fact that in his 2008 article in the Journal of Infectious Diseases (which reported on autopsies of well-preserved victims of the Spanish Flu pandemic), Anthony Fauci concluded that:
“Prevention, diagnosis, prophylaxis, and treatment of secondary bacterial pneumonia, as well as stockpiling of antibiotics and bacterial vaccines, should also be high priorities for pandemic planning.”
What happened to those stockpiles during the covid ‘pandemic’ – or were these never actually created?
UK policy on treating Covid-19
The most damning evidence can be found in this NICE Rapid Guideline (NG163) (published 3 April 2020) that has since been deleted. However, it can be found via the wayback machine here. NG163 is effectively a palliative care pathway that did not recommend the use of antibiotics. It did, however, recommend the use of midazolam for treating patients aged 18 or over with ‘anxiety’ even though midazolam did not have a UK marketing authorisation for this purpose:
The BMJ published the NICE NG163 guidance, in 20 April 2020. In reaction a rapid response letter was sent by eminent experts in palliative care warning of the dangers of administering treatment more appropriate for end-of-life care to covid patients.
As well as NG163 there is also the NICE guidance NG165 issued at the same time on managing suspected or confirmed pneumonia, which explicitly forbade the use of antibiotics in Covid-19 cases:
USA policy on treating Covid-19
Where antibiotics are considered, they are recommended too late, when the patient has acquired pneumonia in hospital or when on a ventilator:
The use of antibiotics in patients with severe or critical COVID-19 should follow guidelines established for other hospitalized patients (i.e., for hospital-acquired pneumonia, ventilator-associated pneumonia, or central line-associated bloodstream infection)
Change in UK antibiotic prescribing patterns
In this twitter post Jikkyleaks looked at UK antibiotic prescribing practice from 2017 to 2022 using the UK online open prescribing system and compared it against projected usage based on historical patterns:
It is clear from the chart that antibiotic prescriptions reduced dramatically in the UK from Spring 2020 to Summer 2021 and then again over the winter of 2021/22.
Note that the Jikkyleaks twitter post exposed an academic paper by Zhong et al that claimed there was no evidence of changes in antibiotic prescribing from the start of the ‘pandemic’.
To verify Jikkyleaks claims here is the time series chart of antibiotic prescriptions direct from the UK open prescribing system.
This paper was published in the BMJ in August 2021 providing an analysis of primary care prescription trends in England during Spring 2020 and concluded that there was a dramatic increase in end-of-life care drugs such as Midazolam. It claims that there was no dramatic change in antibiotic prescribing in 2020 but contains this chart showing the reduction in doxycycline hyclate2 prescribing compared to expected (blue line):
Change in German antibiotics prescribing patterns
Aerzteblatt, the German online journal of medicine and public health reported that:
The outbreak of the COVID-19 pandemic in March 2020 has also led to significant changes in the burden of disease and thus in the prescriptions of medicines in Germany. This can be seen particularly succinctly in the number of prescriptions for antibiotics. These fell to an all-time low in Q2 2020.
From 29.5 million prescriptions in 2019 the figure in 2020 was only 21.8 million, and this reduction occurred during a ’pandemic’. The effect is highest among 18 to 65 year-olds, where around 4.5 million fewer prescriptions (-26%) were issued in 2020 than in 2019.
This chart shows the fall in antibiotic prescriptions:
Physicians defying public health authorities
When physicians chose to use antibiotics to treat patients in defiance of public health authorities, they reported some startling results.
Physicians in Toledo, Spain, empirically administered antibiotics to covid-19 patients during spring 2020, contrary to official guidance. This resulted in zero hospitalizations or deaths in their care homes after they started routine administration. Their resulting mortality over spring 2020 was approx. 7% versus 28% in other comparable care homes (and the 7% died before they started routine antibiotic use).
Likewise in Romania a physician, Flavia Groșan, was reported in the media as approaching covid-19 as “atypical pneumonia”, saying there were huge mistakes with excessive oxygen therapy and intubation:
“Too much oxygen for too lengthy periods at a time, says Groșan, can lead to cerebral edema which in turn can cause death.”
She gave her patients ‘enough’ oxygen for their needs, antibiotics and other cheap medicines. On the choice of antibiotics, she said:
“There are only three antibiotics in the macrolide class, erythromycin, which everyone knows, azithromycin and clarithromycin. I don’t like azithromycin because it’s a weaker copy of clarithromycin. I worked in some very interesting clinical studies on pneumonia and there I learned about the viral tropism of clarithromycin, as well as the anti-inflammatory role of clarithromycin, which no antibiotic has. I have been working with this antibiotic in viral and atypical pneumonias for 10 years. When the pandemic hit I went for an etiological treatment, clarithromycin. Of course, in addition to this antibiotic, there are several adjuvant treatments, because it can’t cope alone. It is a treatment scheme that is my own.”
She reported healing 100% of some 1,000 patients using this approach.
At St Paul’s hospital in Vancouver, Canada, Russell and Walley learned that Covid-19 is not deadly in itself, but it is sepsis that causes the organ failure leading to death. In this article they say:
“The pandemic we’ve all been living through is actually a pandemic of sepsis due to COVID-related pneumonia. Everybody who dies of COVID actually dies of sepsis and pneumonia. Everybody.”
Sepsis is the number one cause of death worldwide. They go on to emphasise the importance of antibiotics and other measures in treating Covid-19:
It’s a complex syndrome that can require antibiotics, oxygen, drugs to stabilize blood pressure, and dialysis to support failing kidneys. In addition to this, there’s also no diagnostic test available to detect sepsis, making the diagnosis a challenge.
Ivermectin protocols as antibiotic treatments
The various protocols for use of ivermectin as an early treatment and prophylactic for covid-19 also include the administration of antibiotics, such as doxycycline and azithromycin, as documented in the Zelenko protocol:
And here in the McCullough protocol which also recommends doxycycline and azithromycin.
And of course, ivermectin is reported to have antimicrobial policies, in itself, as documented here.
Finally, there is this evidence that chloroquine is a potent treatment for SARS.
Note that these protocols recommend antibiotics for high-risk patients. Those are the same patients who may be likely suffering from bacterial pneumonia.
It is worth pointing out that ivermectin and many antibiotics often have antioxidant or anti-inflammatory properties that will also help when treating viral and bacterial infections. This is the case with azithromycin and a cursory search of pubMed results in 58 papers on the topic.
Antibiotics and the common cold
A fascinating letter appeared in the Proceedings of the Royal Society of Medicine in 1958 written by a Dr J. Morrison Ritchie in response to an article on the common cold by Hope Simpson3. In it he describes a study carried out at the Birkenhead Public Health Laboratory on 1,000 volunteers in the winter of 1955/56 where they applied antibiotics for patients suffering cold symptoms. They reported that:
There were 22/581 colds among those receiving antibiotic tablets on the first day, as against 87/338 among those receiving inert control tablets: 3.8 % as against 25.7%, a drop to one-seventh. In the adult industrial population, the proportion was one to nine, and this drop was evident in all the units of the investigation.
Clearly many colds were not viral infections at all but bacterial infections, but such is the overlap in observed respiratory symptoms for these broad classes of pathogen, that absent the administration of antibiotics, this would have escaped attention.
If physicians can easily confuse common cold infections with bacterial infections what is to say they will be able to differentiate between SARS-CoV-2 and bacterial pneumonia?
The use of face coverings may have magnified the harms
The possibility must be raised that the widespread use of face coverings was synergistically harmful when combined with a deliberate policy of restricting antibiotic use.
It has long been recognised that bacterial pneumonia frequently caused by so-called “commensal” bacteria - i.e., those which normally colonise the nose and mouth.
Hence it was not at all surprising that colonies of such bacteria (as well as fungi) were found on nearly all the face coverings used by the volunteers in this study performed in Japan, published in Nature.
The less effective immune system of the elderly is yet another factor which could have acted synergistically with the above to increase the likelihood of them developing bacterial pneumonia under the policies imposed.
Additional Reporting by the Underdog
It is worth reading this article by the Underdog has also reported on changes in antibiotic use, including data on the USA and Australia:
And has also written extensively about the issues with masks.
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Antibiotic that treats many conditions, including acne, chlamydia, sinus infection, and urinary tract infection (UTI)
h/t to Patrick Shaw Stewart for alerting me to this article.