Antibiotic prescribing in patients with COVID-19: rapid review and meta-analysis

• Published in: Clinical microbiology and infection Vol. 27; no. 4; pp. 520 - 531
• Main Authors: Langford, Bradley J., So, Miranda, Raybardhan, Sumit, Leung, Valerie, Soucy, Jean-Paul R., Westwood, Duncan, Daneman, Nick, MacFadden, Derek R.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.04.2021; Published by Elsevier Ltd on behalf of European Society of Clinical Microbiology and Infectious Diseases
• Subjects: Age Factors; Anti-Bacterial Agents - therapeutic use; Antibiotic Prescribing; Antibiotics; Antimicrobial Stewardship; Antimicrobial therapy; Bacterial Infections - complications; Bacterial Infections - drug therapy; Bacterial Infections - epidemiology; Coinfection - drug therapy; Coinfection - epidemiology; COVID-19; COVID-19 - complications; Drug Prescriptions; Drug Utilization; Female; Humans; Male; SARS-CoV-2; Systematic Review; COVID-19; SARS-CoV-2; Antimicrobial therapy; Antibiotics; Antimicrobial Stewardship; Antibiotic Prescribing
• ISSN: 1198-743X; 1469-0691; 1469-0691
• DOI: 10.1016/j.cmi.2020.12.018

The proportion of patients infected with SARS-CoV-2 that are prescribed antibiotics is uncertain, and may contribute to patient harm and global antibiotic resistance. The aim was to estimate the prevalence and associated factors of antibiotic prescribing in patients with COVID-19. We searched MEDLINE, OVID Epub and EMBASE for published literature on human subjects in English up to June 9 2020. We included randomized controlled trials; cohort studies; case series with ≥10 patients; and experimental or observational design that evaluated antibiotic prescribing. The study participants were patients with laboratory-confirmed SARS-CoV-2 infection, across all healthcare settings (hospital and community) and age groups (paediatric and adult). The main outcome of interest was proportion of COVID-19 patients prescribed an antibiotic, stratified by geographical region, severity of illness and age. We pooled proportion data using random effects meta-analysis. We screened 7469 studies, from which 154 were included in the final analysis. Antibiotic data were available from 30 623 patients. The prevalence of antibiotic prescribing was 74.6% (95% CI 68.3–80.0%). On univariable meta-regression, antibiotic prescribing was lower in children (prescribing prevalence odds ratio (OR) 0.10, 95% CI 0.03–0.33) compared with adults. Antibiotic prescribing was higher with increasing patient age (OR 1.45 per 10 year increase, 95% CI 1.18–1.77) and higher with increasing proportion of patients requiring mechanical ventilation (OR 1.33 per 10% increase, 95% CI 1.15–1.54). Estimated bacterial co-infection was 8.6% (95% CI 4.7–15.2%) from 31 studies. Three-quarters of patients with COVID-19 receive antibiotics, prescribing is significantly higher than the estimated prevalence of bacterial co-infection. Unnecessary antibiotic use is likely to be high in patients with COVID-19.