Antibiotics Use in COVID-19 Patients: A Systematic Literature Review

Abstract

The issue of bacterial infections in COVID-19 patients has received increasing attention among scientists. Antibiotics were widely prescribed during the early phase of the pandemic. We performed a literature review to assess the reasons, evidence and practices on the use of antibiotics in COVID-19 in- and outpatients. Published articles providing data on antibiotics use in COVID-19 patients were identified through computerized literature searches on the MEDLINE and SCOPUS databases. Searching the MEDLINE database, the following search terms were adopted: ((antibiotic) AND (COVID-19)). Searching the SCOPUS database, the following search terms were used: ((antibiotic treatment) AND (COVID-19)). The risk of bias in the included studies was not assessed. Both quantitative and qualitative information were summarized by means of textual descriptions. Five-hundred-ninety-three studies were identified, published from January 2020 to 30 October 2022. Thirty-six studies were included in this systematic review. Of the 36 included studies, 32 studies were on the use of antibiotics in COVID-19 inpatients and 4 on antibiotic use in COVID-19 outpatients. Apart from the studies identified and included in the review, the main recommendations on antibiotic treatment from 5 guidelines for the clinical management of COVID-19 were also summarized in a separate paragraph. Antibiotics should not be prescribed during COVID-19 unless there is a strong clinical suspicion of bacterial coinfection or superinfection.

Empiric Antibiotics in COVID-19 Patients: To Give or Not to Give*

“…The prevalence of bacterial coinfection and superinfection during a COVID-19 infection is different than what we have experienced with prior viral pandemics (2)(3)(4). The majority of the current studies report a low prevalence of bacterial coinfection in hospitalized COVID-19 patients, ranging from 3.1% to 8.5%.…”

Pre- and Post-COVID-19 Antimicrobial Resistance Pattern of Pathogens in an Intensive Care Unit

“…The inappropriate use of antibiotics in viral illnesses and in the absence of bacterial co-infection may be an enabling factor for the selection of multidrug-resistant strains. The overuse of antibiotics, especially those most used to treat secondary bacterial infections in COVID-19 patients (amoxicillin, azithromycin, and cephalosporins), has contributed to the development of new, antibiotic-resistant bacterial strains against them [ 10 , 11 , 12 , 13 , 14 ].…”

The pediatric gut bacteriome and virome in response to SARS-CoV-2 infection

“…Indeed, those patients in our cohort who received antibiotics upon admission did so because, in the early days of the pandemic, preventative antibiotics use was indicated for patients whose COVID-19 infection was severe enough to produce symptoms. However, overuse of antibiotics can also lead to the depletion of protective bacteria in the gut, leading many to question whether the preventative use of antibiotics may have been counter-productive during COVID-19 treatment ( Granata et al., 2022 ), which was why this practice was also abandoned in our hospital approximately six months after it was instated.…”