Control of antibiotic resistance and superinfections as a strategy to manage COVID-19 deaths

According to the World Health Organization (WHO), viral infections continue to emerge and pose severe problems to public health. In mid-December 2019, coronavirus (coronavirus disease 2019 [COVID-19]) infection begun scattering from China. Globally, there are growing worries about community infections, in light of pandemic characterization for the outbreak by the WHO. Some studies have found that 1 out of 7 COVID-19 patients have acquired secondary bacterial infection, and half of the patients who have died had such infections. The challenge of antibiotic resistance could become an enormous force contributing to the rise in illness and death associated with COVID-19, as lower respiratory tract infections are among the leading causes of mortality in critically ill ventilated-patients with COVID-19. The increasing prevalence of resistance to penicillin and other drugs among pneumococci has considerably complicated the treatment of acquired pneumonia. Resistance to other classes of antibiotics, traditionally used as alternatives in the treatment of pneumococcal infections, has also increased markedly in the recent years. Although the search for new antibiotics remains a top priority, the pipeline for new antibiotics is not encouraging, making it essential to search for other alternative solutions. Researching promising antimicrobial agents that are effective against COVID-19 as well as Streptococcus pneumoniae, which is a major cause of pneumonia, should be encouraged to reduce mortality related to COVID-19 infections. In this chapter, the relation between secondary infections and antibiotic resistance as contributors to high death rate among COVID-19 patients will be traced and highlighted. The possibility of using antimicrobial agents of plant origin, either independently or in combination with nanostructures, as preventive and/or treatment strategies for infections associated with COVID-19 will be reviewed.