Antimicrobial Use in COVID-19 Patients in the First Phase of the SARS-CoV-2 Pandemic: A Scoping Review

Abstract

This scoping review provides new evidence on the prevalence and patterns of global antimicrobial use in the treatment of COVID-19 patients; identifies the most commonly used antibiotics and clinical scenarios associated with antibiotic prescribing in the first phase of the pandemic; and explores the impact of documented antibiotic prescribing on treatment outcomes in COVID-19 patients. The review complies with PRISMA guidelines for Scoping Reviews and the protocol is registered with the Open Science Framework. In the first six months of the pandemic, there was a similar mean antibiotic prescribing rate between patients with severe or critical illness (75.4%) and patients with mild or moderate illness (75.1%). The proportion of patients prescribed antibiotics without clinical justification was 51.5% vs. 41.9% for patients with mild or moderate illness and those with severe or critical illness. Comparison of patients who were provided antibiotics with a clinical justification with those who were given antibiotics without clinical justification showed lower mortality rates (9.5% vs. 13.1%), higher discharge rates (80.9% vs. 69.3%), and shorter length of hospital stay (9.3 days vs. 12.2 days). In the first 6 months of the pandemic, antibiotics were prescribed for COVID-19 patients regardless of severity of illness. A large proportion of antibiotic prescribing for mild and moderate COVID-19 patients did not have clinical evidence of a bacterial co-infection. Antibiotics may not be beneficial to COVID-19 patients without clinical evidence of a bacterial co-infection.

Co-Infections, Secondary Infections, and Antimicrobial Use in Patients Hospitalized with COVID-19 during the First Five Waves of the Pandemic in Pakistan; Findings and Implications

“…Alongside this, piperacillin plus an enzyme inhibitor, azithromycin, meropenem, ceftriaxone and moxifloxacin were the top five frequently prescribed antibiotics in our study, similar to previous studies from Pakistan [ 37 , 38 ]. Other countries have also documented high prescribing rates of broad-spectrum antibiotics among patients hospitalized with COVID-19 [ 102 , 103 ]. In contrast, a study conducted in Scotland reported amoxicillin, doxycycline and co-amoxiclav were the top three antibiotics prescribed among patients hospitalized with COVID-19 [ 104 ].…”

Antimicrobial Resistance in Rivers: A Review of the Genes Detected and New Challenges

“…This is also underlined by very recent publications (Comber et al, 2020;Nieuwlaat et al, 2020;Strathdee et al, 2020) highlighting that COVID-19 is aggravating AMR, owing to the fact that several COVID-19 diagnoses are associated with bacterial infections and that the majority of COVID-19 patients are treated with antibiotics even when not clinically indicated. A secondary bacterial infection in COVID-19 patients was found only in a few cases (Cong et al, 2021). The WHO also reports that azithromycin is being widely used with hydroxychloroquine, although it is not yet recommended outside of COVID-19 clinical trials.…”

Phage therapy in the Covid-19 era: Advantages over antibiotics

“…For example, 216 million excess doses of antibiotics were prescribed in India during June-September 2020 ( Sulis et al, 2021 ). Similarly, A scoping review by Cong et al indicated 51.4% unjustified antibiotics prescription to the COVID-19 patients in the first phase of the COVID-19 pandemic ( Cong et al, 2021 ). Although there is a higher risk of secondary bacterial infection in patients with severe covid- 19, it should only be used after a thorough evaluation.…”