In the present scenario, antimicrobial resistance (AMR) is rising to a dangerous level and imposing a life threat to large population throughout the world. As per the fact sheet of World Health Organisation (WHO), AMR is one of the top ten global health challenges, along with air pollution climate change, non communicable illnesses, vaccine hesitancy, HIV, and others. AMR, which arises due to the unnecessary and over dose of antimicrobial agents, has continuously been affecting millions of people across the globe. According to the research, AMR was responsible for 700,000 deaths per year in 2014, and the threat is anticipated to grow to 10 million deaths per year by 2050. AMR's huge statistics provide an even greater threat to humans than cancer, which is predicted to kill 8.2 million people globally by 2050.

Unnecessary and extensive use of antibiotics have promoted the emergence and proliferation of resistant bacteria and other pathogens, along with rising AMR, which in turn has resulted in inadequate treatment of common infections. Such consequences necessitate the exploration of a variety of ways to combat this expanding issue of resistance. Currently, ample of antibiotics have been consumed throughout the globe as a primary preventive measure. In England, for example, 81 percent of antibiotics are administered in primary care settings. Subsequently, the broad-spectrum antibiotics have been overprescribed for distinct range of infectious conditions and thus, nowadays these are progressively prescribed as a potential therapeutic target for the treatment of deadly COVID-19 infection. Furthermore, despite the fact that tertiary hospital-level organisations have a significant role in AMR in developed countries, the majority of antibiotics are used in outpatient settings and at the primary level. To this context, the amended antibiotic stewardship regulations in the United Kingdom were designed to drastically alter the role of primary care dispensing.

The pandemic caused by SARS-CoV-2 has caused chaos for the global health and economics. Controlling the spread of SARS-CoV-2 infection and protecting the most vulnerable subjects has necessitated the usage of exceptional measures. However, analgesics, muscle relaxants, anaesthetics, and antimicrobials were all in higher demand in hospitals as a result of the pandemic. Moreover, the widespread lack of life-saving medications may have resulted in unnecessary suffering in parts of the world's poorest countries, while the other places have seen an increase in the use of these products, especially antibiotics, among inpatients. During the Covid-19 pandemic, antimicrobials are used as a multipurpose medication. Antibiotics and antivirals have been utilised as direct therapy so far, but none have been identified as a possible therapy or treatment for this fatal condition. According to the cited report, antibiotics were given in 70% of covid-related hospital cases and 100% of ICU admissions (patients with pneumonia). The research showed that small percentage of COVID-19 patients need administration of antibiotics to cure secondary infections. Such evidences impose a need to avoid antibiotic therapy for prophylaxis to mild or moderate COVID-19 infections unless it is indicated. As envisioned by the current pandemic situation and the published relevant reports, there is still a lack of a fast-track accurate diagnostic tool that can help in the speedy and effective diagnosis and management of COVID-19 which has further resulted in increasing antibiotic usage which is inappropriate.

The over usage of antibiotics is direct threat to patient’s health due to risk of adverse effects as well as increased emergence of AMR and multidrug-resistant microorganisms. During the COVID-19 outbreak, the risks and consequences of utilising a large number of antibacterial agents remain unclear. As a preventive measure, WHO has set the standard that hand sanitizers and disinfectants should be used as often as possible to prevent the transmission of infection. Consequently, unknown bacteria have been exposed to these substances containing antimicrobial moieties on a regular basis at various frequencies and concentrations. As a result, antimicrobials such as antivirals and antifungals have long-term effects on both human and microbial DNA, which in turn is liable to contribute to drug resistance and AMR via mutagenesis pathways that produce epigenetic alterations. In lack of evidences of immediate and long-term negative consequences, the widespread use of hand sanitizers and other cleaning chemicals has been continued which in future may constitute a risk to human health and the environment as well.

Due to a dearth of therapeutic options for dealing with the pandemic, healthcare workers are now using a variety of antimicrobial medications to treat SARS-CoV-2. It has the potential to turn into the next global health emergency. During the COVID-19 pandemic, self-medication for SARS-CoV-2 symptoms without first receiving a COVID-19 test is common, with ivermectin, Levocetirizine, Montelukast, and azithromycin being the most often used self-medication. Antibiotic overuse and misuse in the treatment of COVID-19 may result in the emergence of antimicrobial resistance (AMR). In future, even minor infections might end in death if the inappropriate utilization of antimicrobial drugs leading to global antimicrobial resistance (AMR) is not tackled.

AMR is a challenge that needs a multi-sectoral, integrated strategy with adequate financial backing in order to find a viable solution. COVID-19 is part of a similar process as the unexpected development of SARS-CoV-2, which should be regarded through the same lens as AMR: a holistic, ecological strategy is needed to prevent future biological health dangers to humanity. Awareness and action are crucial in combating the current and emerging public health challenges posed by drug-resistant, multidrug-resistant, and total drug-resistant microorganisms. Future antimicrobial resistance catastrophes pose a substantial threat to low- and middle-income countries. Therefore, appropriate therapies and preventative measures should be developed to counteract the increased threat of antibiotic resistance during this pandemic period.

Laboratory evolution, in combination with whole-genome resequencing and phenotyping analysis, is a powerful technique for understanding the evolutionary dynamics of antibiotic resistance. Furthermore, an antimicrobial drug prescription tracking system, as well as more strictly enforced sales laws, are necessary. To decrease the potent health hazards of widely consumed and externally applied antimicrobials, healthcare systems and social care must ensure that proper awareness is provided to general public about drug misuse, self-medication and AMR. National and international organisations must devise policies to tackle the AMR during and post pandemic era.

(Dr. Sheikh Mansoor is Postdoctoral Researcher at Advanced Centre for Human Genetics and Dr. Aabid Maqbool is Senior Resident Department of Radiation Oncology, Sher-I-Kashmir Institute of Medical Sciences, Soura)