Standard antibiotics should not be given to covid-19 patients on admission to hospital. This is the conclusion of a Dutch team of experts led by Amsterdam UMC. The recommendation is in line with the policy of restraint in the use of antibiotics to prevent resistance of bacteria to these drugs. As a result of this research, the national guidelines on giving antibiotics to corona patients have been amended.
In an article published at the end of last month in Clinical and Microbiological Infection, Dr Elske Sieswerda and Prof Joost Wiersinga and their team describe a scientific guideline for the use of antibiotics in covid-19 patients around the world. Sieswerda: "We wanted to get clarity, because these patients were almost always given antibiotics on admission worldwide. This happened because the patients are very sick, with high fever and inflammation, and had significant abnormalities on imaging of the lungs."
Respiratory tract infection
The fact that many doctors resort to antibiotics is understandable because the critically ill corona patient often has a respiratory tract infection. For pneumonia caused by bacteria, antibiotics are given. But corona is a virus, for which antibiotics do not work. But certainly in the beginning of the pandemic, it was not clear whether a bacterium also played a role in the pneumonia. This is because it is difficult to distinguish the effects of a serious pneumonia caused by a virus from a pneumonia caused by a bacterium. Sieswerda: "In Amsterdam UMC and in the literature, we noticed that during the beginning of the pandemic almost all admitted corona patients were given antibiotics, but virtually no bacterial pathogens were detected. Antibiotic use leads to resistance formation in bacteria and, given the pandemic, there seemed to be a risk of a lot of unnecessary antibiotic use and thus an increase in the resistance problem." Cautious From all existing studies on antibiotics and covid-19 patients, the researchers were able to distil figures. Only 3.5 per cent of patients had a bacterial pneumonia on admission and over 15 per cent developed the infection during their stay in hospital. This is called a secondary infection. Based on these figures, Sieswerda advises - despite the fact that the figures are not yet certain - to be cautious with antibiotics on admission to hospital for covid-19.
Obviously, doctors should be wary of the possibility of a bacteriological infection. Sieswerda therefore recommends that cultures of sputum and blood from corona patients be examined for the presence of pathogenic bacteria. If there are none, the advice is to stop giving antibiotics. Patients who do have a bacterial respiratory infection in addition to covid-19 should be given brief treatment. Secondary infections appear to occur as in other hospitalised patients and Sieswerda refers to existing guidelines for their treatment.
Sieswerda concludes: "A larger study on bacterial infections in COVID-19 is urgently needed to confirm our conclusions and thus prevent even more unnecessary antibiotic use during the current coronapandemic. On the initiative of the Amsterdam UMC Antibiotic Stewardship team, which aims to improve antibiotic prescribing, we have started doing so."