High use of antibiotics in hospitalized COVID-19 patients is ‘often unnecessary’

EDINBURGH, Scotland — Is there really such a thing as “over-medicating” when it comes to COVID-19? A new study finds the very high use of antibiotics in patients hospitalized with coronavirus is often unnecessary. Moreover, researchers in Scotland say the practice actually risks worsening global antimicrobial resistance.

A team from the Universities of Glasgow and Edinburgh has discovered that antibiotic use was very high among hospitalized COVID-19 patients in the United Kingdom during the first wave of the pandemic. This comes despite confirmed bacterial infections due to COVID being uncommon.

The study finds that, overall, 85 percent of COVID-19 patients received one or more antibiotics during their hospital stay, with the highest use in critical care. Thirty-seven percent of patients received a prescription for antibiotics prior to admission.

The report also finds a high use of broad-spectrum antibiotics, which are active against a very wide range of bacteria. The evidence suggests that physicians could reduce this by using more targeted but equally appropriate alternatives.

More bacterial infections coming from the hospitals themselves?

Researchers say not only were bacterial infections in people with COVID-19 uncommon, most of the bacteria discovered in the study came from secondary infections developing more than 48 hours after admission. The team discovered these secondary infections were not specific to COVID-19 infections and were more likely to be hospital-related infections – which are more typical in intensive care units.

Study authors argue over-prescription of antibiotics, and particularly broad-spectrum antibiotics, in the majority of hospitalized COVID patients raises significant concern regarding the potential rise of more drug-resistant pathogens.

In the U.K., current guidelines actually advise against antibiotic use when doctors suspect a respiratory tract infection is COVID-19, without specific evidence of bacterial infection.

“Bacterial chest and bloodstream infections are uncommon complications of COVID-19. This work identifies which bacteria tend to cause these infections when they do occur, helping clinicians to make a more informed choice about the best antibiotics to give people when needed,” says Dr. Clark Russell, Edinburgh’s clinical lecturer in infectious diseases, in a university release.

“Prioritizing and incorporating existing antimicrobial stewardship principles into care plans could help to prevent a rise of drug-resistant infections becoming a longer-term sequela of the pandemic.”

Drug-resistant bugs creating a threat to ‘safe surgery’

Researchers add their findings, in the journal The Lancet Microbe, are shedding new light on the types of medications patients are receiving during the pandemic. Until now, the team calls such reviews “lacking.”

“While some COVID-19 patients will require antibiotics, mostly for secondary infections which develop after admission to hospital, our data shows that not all COVID-19 patients should be prescribed antibiotics,” says study author Dr. Antonia Ho from the MRC-University of Glasgow Centre for Virus Research.

“The longer someone is in hospital, particularly if they are in critical care, the more vulnerable they are to develop secondary infections, and these should continue to be monitored. However, the bugs we identified are similar to those found in patients with hospital-acquired infection, and not specific to COVID-19.”

“We only have safe surgery and medical cures for many life threatening conditions because antibiotics were discovered and mostly still work,” Professor Calum Semple from the University of Liverpool concludes. “Overuse of antibiotics needs to be avoided to prevent emergence of resistance. When the current threat from COVID-19 subsides, the problem of antimicrobial resistance will remain a threat.”

SWNS writer Calum Loudon contributed to this report.