Reducing Unnecessary Antibiotic Use Among Hospitalized Patients with COVID-19

By the bioMérieux Connection Editors

Concerns surrounding the global COVID-19 pandemic continue to flourish as variant strains of the virus emerge in our communities. With a patchwork of varying local policies on mask-wearing and in-person social gatherings and remaining hurdles with vaccination, it is critical to follow CDC guidelines. Additionally, it is important to pay close attention to epidemiological data and continue to work towards improving treatment for COVID-19, including the reduction of antibiotic use.

Antibiotic Use and COVID-19

Antimicrobial resistance (AMR) has long been identified as a serious global health threat. Each year in the U.S., an estimated 2.8 million people get a resistant infection, and more than 35,000 people die as a result. The misuse and overuse of antimicrobials drives increasing antimicrobial resistance.

Recent data from Oxford Academic’s Open Forum Infectious Diseases suggested that more than 70% of COVID-19 patients receive antibiotic therapy despite low prevalence of co-infection. Without the detection of a bacterial co-infection, antibiotic treatment is not needed and when prescribed unnecessarily, contributes to AMR.

According to Stat News, the gap between patients treated with an antibiotic versus those who actually need one can be largely explained by the fact that many antibiotics are being prescribed within 48 hours of admission. Generally, that is before medical teams are likely to have diagnostic test results from the lab confirming bacterial infection.

Examining Solutions for Antibiotic Overuse in COVID-19 Patients

A recent study conducted at the University of Chicago Medicine examined how we can limit antibiotic overexposure amidst the pandemic. The authors write that, “While initiating empiric antibiotics for [community-acquired bacterial pneumonia] may be reasonable, antibiotic therapy should be re-evaluated once COVID-19 pneumonia is confirmed. 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.”

The study concluded that the implementation of guidelines accomplished the following: reduced the use of antibiotics from over 70% of patients down to just 42%, reduced duration of antibiotic treatment by 1.3 days, and reduced duration of antibiotic therapy by 2.8 days for those with antibiotics aimed at atypical bacteria. The reduction of antibiotic use and the duration of shortened treatment had no impact upon clinical outcomes.

The implementation and success of such guidelines demonstrates the importance of antimicrobial stewardship programs (ASPs) and interventions in the fight against both AMR and COVID-19. Use of advanced diagnostics, vaccines, and improvements in public policy can support stewardship programs and also help address AMR and COVID-19 on multiple fronts. Without widespread intervention, these dual health threats will continue to worsen, leading to adverse health outcomes and decreased antibiotic efficacy for future generations.

Opinions expressed in this article are not necessarily those of bioMérieux, Inc.

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