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.

Inappropriate Antibiotic Use in Zimbabwe in the COVID-19 Era: A Perfect Recipe for Antimicrobial Resistance

“…First, COVID-19 infection has some similarities with bacterial pneumonia. Secondly, the lack of effective SARS-CoV-2 treatment and management guidelines leads to uncertainty, and potentially to the overuse of antibiotics [ 10 ]. Lastly, COVID-19 patients may acquire superimposed bacterial infections that require antimicrobial treatment [ 11 , 12 ].…”

COVID-19 Autopsies Reveal Underreporting of SARS-CoV-2 Infection and Scarcity of Co-infections

“…A further caveat is that the conclusions from our study may not be generalizable to all countries. There is wide variation in reporting COVID-19 deaths and in the use of antibiotics between different health systems ( 44 , 82 – 85 ). However, as rules for COVID-19 reporting in Switzerland are stringent, it is likely that underreporting of COVID-19 mortality is even more pronounced in other countries.…”

Treatment paradigms in Parkinson's Disease and Covid-19

“…Considering the choice of antibiotics, most physicians adhere to local community-acquired pneumonia guidelines ( Bendala Estrada et al, 2021 ). In a meta-analysis of 13,932 Covid-19 patients, beta-lactams, especially third-generation cephalosporines, were the most commonly administered agents (72.0%), followed by macrolides (60.2%) and fluoroquinolones (13.3%) ( Bendala Estrada et al, 2021 ).…”

“…Considering the choice of antibiotics, most physicians adhere to local community-acquired pneumonia guidelines ( Bendala Estrada et al, 2021 ). In a meta-analysis of 13,932 Covid-19 patients, beta-lactams, especially third-generation cephalosporines, were the most commonly administered agents (72.0%), followed by macrolides (60.2%) and fluoroquinolones (13.3%) ( Bendala Estrada et al, 2021 ). In a different meta-analysis of 375 patients, fluoroquinolones were the most commonly used antibiotics (56.8%), followed by ceftriaxone (39.5%) and azithromycin (29.1%) ( Chedid et al, 2021 ).…”

“…Macrolides had been widely used in Covid-19 treatment during the first months of the pandemic due to their antiviral features ( Bendala Estrada et al, 2021 ). Initial studies had shown that azithromycin, either alone or in combination with hydroxychloroquine, was effective against SARS-CoV-2 ( Gautret et al, 2020 ; Touret et al, 2020 ), while macrolides use was associated to a higher survival ratio in Covid-19 patients ( Bendala Estrada et al, 2021 ). Although generally well-tolerated, macrolides exhibit a variety of side effects which are particularly relevant for PwP.…”