Inadequate Use of Antibiotics in the Covid-19 Era: Effectiveness of Antibiotic Therapy

Abstract

Background: Since December 2019, the COVID-19 pandemic has changed the concept of medicine. This work aims to analyze the use of antibiotics in patients admitted to the hospital due to SARS-CoV-2 infection. Methods: This work analyzes the use and effectiveness of antibiotics in hospitalized patients with COVID-19 based on data from the SEMI-COVID-19 registry, an initiative to generate knowledge about this disease using data from electronic medical records. Our primary endpoint was all-cause in-hospital mortality according to antibiotic use. The secondary endpoint was the effect of macrolides on mortality. Results: Of 13,932 patients, antibiotics were used in 12,238. The overall death rate was 20.7% and higher among those taking antibiotics (87.8%). Higher mortality was observed with use of all antibiotics (OR 1.40, 95%CI 1.21-1.62; p<.001) except macrolides, which had a higher survival rate (OR 0.70, 95%CI 0.64-0.76; p<.001). The decision to start antibiotics was influenced by presence of increased inflammatory markers and any kind of infiltrate on an x-ray. Patients receiving antibiotics required respiratory support and were transferred to intensive care units more often. Conclusions: Bacterial co-infection was uncommon among COVID-19 patients, yet use of antibiotics was high. There is insufficient evidence to support widespread use of empiric antibiotics in these patients. Most may not require empiric treatment and if they do, there is promising evidence regarding azithromycin as a potential COVID-19 treatment.

The landscape of antibiotic usage among COVID-19 patients in the early phase of pandemic: a Malaysian national perspective

“…Despite the fact that information on antibiotic regimes was not included in the interim Malaysian guidelines for clinical management of COVID-19 [ 16 ], the choices of antibiotic usage for COVID-19 patients with suspected bacterial co-infection were as recommended in the Malaysian National Antibiotic Guideline 2019 for pneumonia [ 30 ]. In Spain, amoxicillin and amoxicillin/clavulanic acid were the favourites (72.0%) [ 31 ], but they were prescribed at a higher rate in comparison with our study (37.8 to 56.7%). Although ceftriaxone was the second most common antibiotic used among COVID-19 patients in other countries such as the United States and Bangladesh, where it was prescribed at a rate of nearly 54.0% [ 10 , 32 ], the usage was low in this study (12.3%).…”

The Management of Urinary Tract Infections during the COVID-19 Pandemic: What Do We Need to Know?

“…For this reason, antimicrobial treatment is now prescribed earlier, and broad-spectrum antibiotics has been more frequently used in patients with suspected UTI in order to avoid severe infections and hospitalizations. Recently, Bendala Estrada et al demonstrated in a multicenter, retrospective study, that the overall percentage of bacterial co-infection among patients with COVID-19 was low, but the use of antibiotics was high [4]. Moreover, the Uro 2022, 2 56 recent International Severe Acute Respiratory and Emerging Infections Consortium (IS-ARIC) report demonstrated that 62% of patients with COVID-19 had received antimicrobial therapy, even though the prevalence of bacterial infections in COVID-19 has been low [5].…”

Adverse effects of vaccinations and potential therapies against COVID-19

“…W tych ostatnich przypadkach wyniki badań pochodzą nie tylko z badań in vitro, lecz także u pacjentów. Do wy-ników tych należy więc podejść z dużą ostrożnością [16,17]. Jak wskazano na wstępie, szczepionki nie powinny być traktowane ani łagodniej, ani bardziej restrykcyjnie niż wiele produktów na rynku.…”