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

• Published in: Antibiotics (Basel) Vol. 10; no. 6; p. 745
• Main Authors: Cong, Wenjuan, Poudel, Ak Narayan, Alhusein, Nour, Wang, Hexing, Yao, Guiqing, Lambert, Helen
• Format: Journal Article
• Language: English
• Published: Basel MDPI AG 19.06.2021; MDPI
• Subjects: antibiotic use; Antibiotics; Antiinfectives and antibacterials; Antimicrobial agents; Bacterial infections; clinical justification; Coronaviruses; COVID-19; COVID-19 patients; disease severity; Hospitalization; Hospitals; Illnesses; Infections; Infectious diseases; Medical research; Mortality; Pandemics; Patients; Review; secondary infections; Severe acute respiratory syndrome coronavirus 2; Viral diseases; United States > US; Italy
• ISSN: 2079-6382; 2079-6382
• DOI: 10.3390/antibiotics10060745

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.