Recommendations for antibacterial therapy in adults with COVID-19 – an evidence based guideline

Abstract

SCOPE: The Dutch Working Party on Antibiotic Policy constituted a multidisciplinary expert committee to provide evidence-based recommendation for the use of antibacterial therapy in hospitalized adults with a respiratory infection and suspected or proven 2019 Coronavirus disease (COVID-19). METHODS: We performed a literature search to answer four key questions. The committee graded the evidence and developed recommendations by using Grading of Recommendations Assessment, Development, and Evaluation methodology. QUESTIONS ADDRESSED BY THE GUIDELINE AND RECOMMENDATIONS: We assessed evidence on the risk of bacterial infections in hospitalized COVID-19 patients, the associated bacterial pathogens, how to diagnose bacterial infections and how to treat bacterial infections. Bacterial co-infection upon admission was reported in 3.5% of COVID-19 patients, while bacterial secondary infections during hospitalization occurred up to 15%. No or very low quality evidence was found to answer the other key clinical questions. Although the evidence base on bacterial infections in COVID-19 is currently limited, available evidence supports restrictive antibiotic use from an antibiotic stewardship perspective, especially upon admission. To support restrictive antibiotic use, maximum efforts should be undertaken to obtain sputum and blood culture samples as well as pneumococcal urinary antigen testing. We suggest to stop antibiotics in patients who started antibiotic treatment upon admission when representative cultures as well as urinary antigen tests show no signs of involvement of bacterial pathogens after 48 hours. For patients with secondary bacterial respiratory infection we recommend to follow other guideline recommendations on antibacterial treatment for patients with hospital-acquired and ventilator-associated pneumonia. An antibiotic treatment duration of five days in patients with COVID-19 and suspected bacterial respiratory infection is recommended upon improvement of signs, symptoms and inflammatory markers. Larger, prospective studies about the epidemiology of bacterial infections in COVID-19 are urgently needed to confirm our conclusions and ultimately prevent unnecessary antibiotic use during the COVID-19 pandemic.

References 36

1. 1.

   This reference’s wording can’t be shown under the paper’s licence.

   Not in our library10.1056/nejmoa2002032

2. 2.

   This reference’s wording can’t be shown under the paper’s licence.

   Not in our library10.1016/s0140-6736(20)30566-3

3. 3.

   This reference’s wording can’t be shown under the paper’s licence.

   Not in our library10.1172/jci137244

4. 4.

   This reference’s wording can’t be shown under the paper’s licence.

   Not in our library10.1136/bmj.m1091

5. 5.

   This reference’s wording can’t be shown under the paper’s licence.

   Not in our library10.1002/jmv.25781

6. 6.

   This reference’s wording can’t be shown under the paper’s licence.

   Not in our library10.1164/rccm.202003-0543oc

7. 7.

   This reference’s wording can’t be shown under the paper’s licence.

   Not in our library10.1001/jama.2020.1585

8. 8.

   This reference’s wording can’t be shown under the paper’s licence.

   Not in our library10.1016/s2213-2600(20)30079-5

9. 9.

   This reference’s wording can’t be shown under the paper’s licence.

   Not in our library10.1016/j.annonc.2020.03.296

10. 10.

    This reference’s wording can’t be shown under the paper’s licence.

    Not in our library10.1093/cid/ciaa272

11. 11.

    This reference’s wording can’t be shown under the paper’s licence.

    Not in our library10.1093/cid/ciaa530

12. 12.

    This reference’s wording can’t be shown under the paper’s licence.

    Not in our library10.1093/cid/ciw353

13. 13.

    This reference’s wording can’t be shown under the paper’s licence.

    Not in our library10.1093/cid/cir301

14. 14.
    A systematic review and meta-analysis of the effects of antibiotic consumption on antibiotic resistance · 2014

    No notice
15. 15.

    This reference’s wording can’t be shown under the paper’s licence.

    Not in our library

16. 16.

    This reference’s wording can’t be shown under the paper’s licence.

    Not in our library

17. 17.

    This reference’s wording can’t be shown under the paper’s licence.

    Not in our library10.1136/bmj.39489.470347.ad

18. 18.

    This reference’s wording can’t be shown under the paper’s licence.

    Not in our library10.1016/j.cmi.2020.07.016

19. 19.

    This reference’s wording can’t be shown under the paper’s licence.

    Not in our library10.1016/s0140-6736(20)30211-7

20. 20.

    This reference’s wording can’t be shown under the paper’s licence.

    Not in our library10.1001/jamainternmed.2020.0994

21. 21.

    This reference’s wording can’t be shown under the paper’s licence.

    Not in our library10.1001/jama.2020.6266

22. 22.

    This reference’s wording can’t be shown under the paper’s licence.

    Not in our library

23. 23.

    This reference’s wording can’t be shown under the paper’s licence.

    Not in our library

24. 24.

    This reference’s wording can’t be shown under the paper’s licence.

    Not in our library

25. 25.

    This reference’s wording can’t be shown under the paper’s licence.

    Not in our library10.1016/s0140-6736(20)30183-5

26. 26.

    This reference’s wording can’t be shown under the paper’s licence.

    Not in our library10.1056/nejmoa2004500

27. 27.
    Prediction models for diagnosis and prognosis of covid-19: systematic review and critical appraisal · 2020

    No notice
28. 28.

    This reference’s wording can’t be shown under the paper’s licence.

    Not in our library10.1016/j.amjmed.2005.01.006

29. 29.

    This reference’s wording can’t be shown under the paper’s licence.

    Not in our library10.1056/nejm199701233360402

30. 30.

    This reference’s wording can’t be shown under the paper’s licence.

    Not in our library10.1136/thorax.58.5.377

31. 31.

    This reference’s wording can’t be shown under the paper’s licence.

    Not in our library10.1164/rccm.201908-1581st

32. 32.

    This reference’s wording can’t be shown under the paper’s licence.

    Not in our library10.1007/s00134-020-06022-5

33. 33.

    This reference’s wording can’t be shown under the paper’s licence.

    Not in our library

34. 34.

    This reference’s wording can’t be shown under the paper’s licence.

    Not in our library10.1007/s00134-019-05866-w

35. 35.

    This reference’s wording can’t be shown under the paper’s licence.

    Not in our library10.1016/j.cmi.2020.04.024

36. 36.

    This reference’s wording can’t be shown under the paper’s licence.

    Not in our library10.1093/ofid/ofw249

Cited by papers we hold 5

• Gut microbiome dysbiosis in antibiotic-treated COVID-19 patients is associated with microbial translocation and bacteremia · 2022
  No notice
• Antimicrobial resistance (AMR) in COVID-19 patients: a systematic review and meta-analysis (November 2019–June 2021) · 2022
  No notice
• Co-infections, secondary infections, and antimicrobial use in patients hospitalised with COVID-19 during the first pandemic wave from the ISARIC WHO CCP-UK study: a multicentre, prospective cohort study · 2021
  No notice
• A 29-mRNA host response test from blood accurately distinguishes bacterial and viral infections among emergency department patients · 2021
  Not checked
• Increased Use of Antibiotics in the Intensive Care Unit During Coronavirus Disease (COVID-19) Pandemic in a Brazilian Hospital · 2021
  Not checked

Reads

A person counts once a day per paper. We keep no cookie and no address: a reader is a hash that changes every day. Any month under five reads shows no number.