Investigations of early pandemic care continue to reveal high rates of antibiotic prescriptions among COVID-19 patients — both before and during hospitalization. The findings highlight the challenge faced by clinicians who wish to avoid overusing these drugs, but at the same time require access to potentially lifesaving treatment for a new respiratory disease. 

In a hospital study from the United Kingdom published last week, bacterial infections were found to be rare, confirming results of other studies to date. But from February to June 2020, 37% of more than 36,000 study participants had received antimicrobials before hospital admission, and 85% of more than 46,000 patients received one or more antimicrobials during their stay. Not surprisingly, the highest number of these prescriptions was in critical care.

The results support those of an earlier meta-analysis, wrote senior author Antonia Ho, Ph.D., of the Medical Research Council — University of Glasgow, U.K. That study found that two-thirds of patients with COVID-19 were prescribed antibiotics through June 2020, although fewer than 10% had a bacterial infection. And although prescribing rates are changing as COVID-19 treatments evolve, these studies show that “the frequency and nature of antimicrobial use are concerning,” wrote Ho, an infectious disease specialist. 

Other researchers have also expressed concern about the use of antibiotics without evidence of bacterial pneumonia in COVID-19 patients. 

“While initiating empiric antibiotics for community-acquired bacterial pneumonia [CABP] may be reasonable, antibiotic therapy should be re-evaluated once COVID-19 pneumonia is confirmed,” wrote Natasha N. Pettit, Ph.D., and colleagues from The University of Chicago Medicine, in a recent investigation.

A stewardship intervention succeeds in COVID pneumonia

Their study, published June 2, followed outcomes at a Chicago hospital that was able to reduce inappropriate prescriptions by formalizing guidelines for initiating and discontinuing antibiotics for CABP in COVID-19 patients. Antimicrobial prescriptions for suspected infection then fell — from 75% pre-guidelines to 42% post-guidelines. And the median duration of antibiotic therapy was also reduced, by 1.3 days, the investigators found.

The intervention appeared to encourage appropriate prescribing. Before the formal guidelines were introduced, clinicians initiated antibiotics based on criteria consistent with the guidelines in 68% of cases. This number rose to 87% post-intervention, the authors reported. Clinical outcomes were no different between pre- and post-guidelines patients, they added.

“Prescribing empiric antibiotics when the clinical presentation is inconsistent with bacterial pneumonia or continuing antibiotics longer than necessary should be avoided in order to minimize the potential for adverse consequences,” Petit and colleagues concluded.