RATIONAL USE OF ANTIBIOTICS DURING THE COVID-19 PANDEMIC
Antibiotics during COVID-19
Keywords:
antibiotics, COVID-19, antimicrobial resistance, bacteria
Abstract
Introduction/Aim: The global COVID-19 pandemic has long been considered an emergency, with the number of cases growing exponentially, despite constant efforts to control the infection. Although the disease is caused by the SARS-CoV-2 virus, most patients are treated with antibiotic therapy. The long-term effects of such broad antibiotics use on antimicrobial resistance are still unknown and are a matter for concern. The aim of this paper is: to determine, based on the available literature, the impact of the COVID-19 pandemic on the use of antibiotics; to determine the global situation regarding antimicrobial resistance; to identify key areas where urgent changes are needed.
Methods: A systematic review of the current literature on the use of antibiotics in COVID-19 treatment was conducted. The PubMed and MEDLINE databases were searched for papers published between March 2020 and September 2021.
Results: Between 76.8% and 87.8% of patients with COVID-19 were treated with antibiotics. Antibiotics were less frequently prescribed to children, as compared to adults (38.5%, compared to 83.4%). The most commonly administered antibiotics were fluoroquinolones (20.0%), macrolides (18.9%), β-lactam antibiotics (15.0%), and cephalosporins (15.0%). Self-medication with antibiotics to prevent and treat COVID-19 has been identified as one of the important factors contributing to antimicrobial resistance.
Conclusion: The impact of COVID-19 on global antimicrobial resistance is still unknown and is likely to be unevenly distributed in the general population. Although various antibiotics have been used to treat patients with COVID-19, their role and the need for their application in the treatment of this infection remains to be determined. For now, there are no reliable data as to whether the use of antibiotics in COVID-19 cases without associated bacterial infections has any effect on the course of the disease and mortality.
References
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19. Timbrook TT, Hueth KD, Ginocchio CC. Identification of bacterial co-detections in COVID-19 critically Ill patients by BioFire® FilmArray® pneumonia panel: a systematic review and meta-analysis. Diagn Microbiol Infect Dis. 2021;101(3):115476. doi:10.1016/j.diagmicrobio.2021.115476
20. Ruuskanen O, Lahti E, Jennings LC, Murdoch DR. Viral pneumonia. Lancet. 2011 Apr 9; 377(9773):1264-75. doi: 10.1016/S0140-6736(10)61459-6
21. Chong WH, Saha BK, Ananthakrishnan Ramani, Chopra A. State-of-the-art review of secondary pulmonary infections in patients with COVID-19 pneumonia. Infection. 2021; 49(4):591-605. doi:10.1007/s15010-021-01602-z
22. Peng J, Wang Q, Mei H, et al. Fungal co-infection in COVID-19 patients: evidence from a systematic review and meta-analysis. Aging (Albany NY). 2021;13(6):7745-7757. doi:10.18632/aging.202742
23. Torres NF, Chibi B, Middleton LE, Solomon VP, Mashamba-Thompson TP. Evidence of factors influencing self-medication with antibiotics in low and middle-income countries: a systematic scoping review. Public Health. 2019;168:92-101. doi: 10.1016/j.puhe.2018.11.018.
24. Lescure D, Paget J, Schellevis F, van Dijk L. Determinants of Self-Medication With Antibiotics in European and Anglo-Saxon Countries: A Systematic Review of the Literature. Front Public Health. 2018;6:370. doi: 10.3389/fpubh.2018.00370
25. Sunny TP, Jacob R, Krishnakumar K, Varghese S. Self-medication: Is a serious challenge to control antibiotic resistance? Natl. J. Physiol. Pharm. Pharmacol. 2019; 9:821–827. doi: 10.5455/njppp.2019.9.0620508062019.
26. Morgan DJ, Okeke IN, Laxminarayan R, Perencevich EN, Weisenberg S. Non-prescription antimicrobial use worldwide: a systematic review. Lancet Infect Dis. 2021;11(9):692-701. doi: 10.1016/S1473-3099(11)70054-8
27. Rajkumar RP. COVID-19 and mental health: A review of the existing literature. Asian J Psychiatr. 2020 Aug;52:102066. doi: 10.1016/j.ajp.2020.102066
28. Zhang A, Hobman EV, De Barro P, Young A, Carter DJ, Byrne M. Self-Medication with Antibiotics for Protection against COVID-19: The Role of Psychological Distress, Knowledge of, and Experiences with Antibiotics. Antibiotics (Basel). 2021;10(3):232. doi:10.3390/antibiotics10030232
29. Quincho-Lopez A, Benites-Ibarra CA, Hilario-Gomez MM, Quijano-Escate R, Taype-Rondan A. Self-medication practices to prevent or manage COVID-19: A systematic review. PLoS One. 2021;16(11):e0259317. doi:10.1371/journal.pone.0259317
30. Monaghesh E, Hajizadeh A. The role of telehealth during COVID-19 outbreak: a systematic review based on current evidence. BMC Public Health. 2020; 20(1):1193. doi: 10.1186/s12889-020-09301-4
31. Entezarjou A, Calling S, Bhattacharyya T, et al. Antibiotic Prescription Rates After eVisits Versus Office Visits in Primary Care: Observational Study. JMIR Med Inform. 2021;9(3):e25473. doi:10.2196/25473)
32. Ray KN, Shi Z, Gidengil CA, Poon SJ, Uscher-Pines L, Mehrotra A. Antibiotic Prescribing During Pediatric Direct-to-Consumer Telemedicine Visits. Pediatrics. 2019;143(5):e20182491. doi:10.1542/peds.2018-2491
33. Ray KN, Martin JM, Wolfson D, Schweiberger K, Schoemer P, Cepullio C, et al. Antibiotic Prescribing for Acute Respiratory Tract Infections During Telemedicine Visits Within a Pediatric Primary Care Network. Acad Pediatr. 2021;21(7):1239-1243. doi: 10.1016/j.acap.2021.03.008
34. Merchel Piovesan Pereira B, Tagkopoulos I. Benzalkonium Chlorides: Uses, Regulatory Status, and Microbial Resistance. Appl Environ Microbiol. 2019;85(13):e00377-19. doi: 10.1128/AEM.00377-19
35. Lewis K. Persister cells, dormancy and infectious disease. Nat Rev Microbiol. 2007;5(1):48–56. doi: 10.1038/nrmicro1557
36. Rizvi SG, Ahammad SZ. COVID-19 and antimicrobial resistance: A cross-study. Sci Total Environ. 2021; 807(2):150873. doi:10.1016/j.scitotenv.2021.150873
37. Tomczyk S, Taylor A, Brown A, de Kraker M, El-Saed A, Alshamrani M, et al. Impact of the COVID-19 pandemic on the surveillance, prevention and control of antimicrobial resistance: a global survey. J Antimicrob Chemother. 2021;76(11):3045-3058. doi:10.1093/jac/dkab300
38. Hirabayashi A, Kajihara T, Yahara K, Shibayama K, Sugai M. Impact of the COVID-19 pandemic on the surveillance of antimicrobial resistance. J Hosp Infect. 2021;117:147-156. doi:10.1016/j.jhin.2021.09.011
39. McNeil JC, Flores AR, Kaplan SL, Hulten KG. The indirect impact of the SARS-CoV-2 pandemic on invasive group A Streptococcus, Streptococcus Pneumoniae and Staphylococcus Aureus infections in Houston area children. Pediatr Infect Dis J. 2021;40(8):e313–e316 doi: 10.1097/INF.0000000000003195.
2. Ioannidis JPA. Infection fatality rate of COVID-19 inferred from seroprevalence data. Bull World Health Organ. 2021;99(1):19-33F. doi:10.2471/BLT.20.265892
3. Giri M, Puri A, Wang T, Guo S. Comparison of clinical manifestations, pre-existing comorbidities, complications and treatment modalities in severe and non-severe COVID-19 patients: A systemic review and meta-analysis. Sci Prog. 2021; 104(1): 368504211000906. doi:10.1177/00368504211000906
4. Laxminarayan R, Duse A, Wattal C, Zaidi AK, Wertheim HF, Sumpradit N, et al. Antibiotic resistance-the need for global solutions. Lancet Infect Dis. 2013;13(12):1057-98. doi: 10.1016/S1473-3099(13)70318-9. Erratum in: Lancet Infect Dis. 2014;14(3):182.
5. Bendala Estrada AD, Calderón Parra J, Fernández Carracedo E, Muiño Míguez A, Ramos Martínez A, Muñez Rubio E, et al. Inadequate use of antibiotics in the covid-19 era: effectiveness of antibiotic therapy. BMC Infect Dis. 2021;21(1):1144. doi: 10.1186/s12879-021-06821-1
6. Langford BJ, So M, Raybardhan S, Leung V, Soucy JR, Westwood D, et al. Antibiotic prescribing in patients with COVID-19: rapid review and meta-analysis. Clin Microbiol Infect. 2021;27(4):520-531. doi:10.1016/j.cmi.2020.12.018
7. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA. 2020;323(11):1061-1069. doi: 10.1001/jama.2020.1585. Erratum in: JAMA. 2021;325(11):1113
8. Damle B, Vourvahis M, Wang E, Leaney J, Corrigan B. Clinical Pharmacology Perspectives on the Antiviral Activity of Azithromycin and Use in COVID-19. Clin Pharmacol Ther. 2020;108(2):201-211. doi: 10.1002/cpt.1857. PMID: 32302411
9. Vitiello A, Ferrara F. A short focus, azithromycin in the treatment of respiratory viral infection COVID-19: efficacy or inefficacy? Immunol Res. 2021;1-5. doi:10.1007/s12026-021-09244-x
10. Popp M, Stegemann M, Riemer M, Metzendorf M, Romero CS, Mikolajewska A, et al. Antibiotics for the treatment of COVID‐19. Cochrane Database of Systematic Reviews 2021; 10:CD015025. doi: 10.1002/14651858.CD015025
11. RECOVERY Collaborative Group. Azithromycin in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial. Lancet. 2021;397(10274):605-612. doi: 10.1016/S0140-6736(21)00149-5
12. PRINCIPLE Trial Collaborative Group. Azithromycin for community treatment of suspected COVID-19 in people at increased risk of an adverse clinical course in the UK (PRINCIPLE): a randomised, controlled, open-label, adaptive platform trial. Lancet. 2021;397(10279):1063-1074. doi: 10.1016/S0140-6736(21)00461-X
13. Yin X, Xu X, Li H, Jiang N, Wang J, Lu Z, et al. Evaluation of early antibiotic use in non-severe COVID-19 patients without bacterial infection: Early antibiotic use in non-severe COVID-19. Int J Antimicrob Agents. 2021; 106462. doi:10.1016/j.ijantimicag.2021.106462
14. Gerver SM, Guy R, Wilson K, Thelwall S, Nsonwu O, Rooney G, et al. National surveillance of bacterial and fungal coinfection and secondary infection in COVID-19 patients in England: lessons from the first wave. Clin Microbiol Infect. 2021;27(11):1658-1665. doi:10.1016/j.cmi.2021.05.040)
15. Lansbury L, Lim B, Baskaran V, Lim WS. Co-infections in people with COVID-19: a systematic review and meta-analysis. J Infect. 2020;81(2):266–275 doi: 10.1016/j.jinf.2020.05.046
16. Chong WH, Saha BK, Ananthakrishnan Ramani, Chopra A. State-of-the-art review of secondary pulmonary infections in patients with COVID-19 pneumonia. Infection. 2021;49(4):591-605. doi:10.1007/s15010-021-01602-z
17. Ruiz-Bastián M, Falces-Romero I, Ramos-Ramos JC, de Pablos M, García-Rodríguez J; SARS-CoV-2 Working Group. Bacterial co-infections in COVID-19 pneumonia in a tertiary care hospital: Surfing the first wave. Diagn Microbiol Infect Dis. 2021;101(3):115477. doi:10.1016/j.diagmicrobio.2021.115477
18. Metlay JP, Waterer GW, Long AC, Anzueto A, Brozek J, Crothers K. Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American thoracic society and infectious diseases society of America. Am J Respir Crit Care Med. 2019;200(7):e45–e67 doi: 10.1164/rccm.201908-1581ST
19. Timbrook TT, Hueth KD, Ginocchio CC. Identification of bacterial co-detections in COVID-19 critically Ill patients by BioFire® FilmArray® pneumonia panel: a systematic review and meta-analysis. Diagn Microbiol Infect Dis. 2021;101(3):115476. doi:10.1016/j.diagmicrobio.2021.115476
20. Ruuskanen O, Lahti E, Jennings LC, Murdoch DR. Viral pneumonia. Lancet. 2011 Apr 9; 377(9773):1264-75. doi: 10.1016/S0140-6736(10)61459-6
21. Chong WH, Saha BK, Ananthakrishnan Ramani, Chopra A. State-of-the-art review of secondary pulmonary infections in patients with COVID-19 pneumonia. Infection. 2021; 49(4):591-605. doi:10.1007/s15010-021-01602-z
22. Peng J, Wang Q, Mei H, et al. Fungal co-infection in COVID-19 patients: evidence from a systematic review and meta-analysis. Aging (Albany NY). 2021;13(6):7745-7757. doi:10.18632/aging.202742
23. Torres NF, Chibi B, Middleton LE, Solomon VP, Mashamba-Thompson TP. Evidence of factors influencing self-medication with antibiotics in low and middle-income countries: a systematic scoping review. Public Health. 2019;168:92-101. doi: 10.1016/j.puhe.2018.11.018.
24. Lescure D, Paget J, Schellevis F, van Dijk L. Determinants of Self-Medication With Antibiotics in European and Anglo-Saxon Countries: A Systematic Review of the Literature. Front Public Health. 2018;6:370. doi: 10.3389/fpubh.2018.00370
25. Sunny TP, Jacob R, Krishnakumar K, Varghese S. Self-medication: Is a serious challenge to control antibiotic resistance? Natl. J. Physiol. Pharm. Pharmacol. 2019; 9:821–827. doi: 10.5455/njppp.2019.9.0620508062019.
26. Morgan DJ, Okeke IN, Laxminarayan R, Perencevich EN, Weisenberg S. Non-prescription antimicrobial use worldwide: a systematic review. Lancet Infect Dis. 2021;11(9):692-701. doi: 10.1016/S1473-3099(11)70054-8
27. Rajkumar RP. COVID-19 and mental health: A review of the existing literature. Asian J Psychiatr. 2020 Aug;52:102066. doi: 10.1016/j.ajp.2020.102066
28. Zhang A, Hobman EV, De Barro P, Young A, Carter DJ, Byrne M. Self-Medication with Antibiotics for Protection against COVID-19: The Role of Psychological Distress, Knowledge of, and Experiences with Antibiotics. Antibiotics (Basel). 2021;10(3):232. doi:10.3390/antibiotics10030232
29. Quincho-Lopez A, Benites-Ibarra CA, Hilario-Gomez MM, Quijano-Escate R, Taype-Rondan A. Self-medication practices to prevent or manage COVID-19: A systematic review. PLoS One. 2021;16(11):e0259317. doi:10.1371/journal.pone.0259317
30. Monaghesh E, Hajizadeh A. The role of telehealth during COVID-19 outbreak: a systematic review based on current evidence. BMC Public Health. 2020; 20(1):1193. doi: 10.1186/s12889-020-09301-4
31. Entezarjou A, Calling S, Bhattacharyya T, et al. Antibiotic Prescription Rates After eVisits Versus Office Visits in Primary Care: Observational Study. JMIR Med Inform. 2021;9(3):e25473. doi:10.2196/25473)
32. Ray KN, Shi Z, Gidengil CA, Poon SJ, Uscher-Pines L, Mehrotra A. Antibiotic Prescribing During Pediatric Direct-to-Consumer Telemedicine Visits. Pediatrics. 2019;143(5):e20182491. doi:10.1542/peds.2018-2491
33. Ray KN, Martin JM, Wolfson D, Schweiberger K, Schoemer P, Cepullio C, et al. Antibiotic Prescribing for Acute Respiratory Tract Infections During Telemedicine Visits Within a Pediatric Primary Care Network. Acad Pediatr. 2021;21(7):1239-1243. doi: 10.1016/j.acap.2021.03.008
34. Merchel Piovesan Pereira B, Tagkopoulos I. Benzalkonium Chlorides: Uses, Regulatory Status, and Microbial Resistance. Appl Environ Microbiol. 2019;85(13):e00377-19. doi: 10.1128/AEM.00377-19
35. Lewis K. Persister cells, dormancy and infectious disease. Nat Rev Microbiol. 2007;5(1):48–56. doi: 10.1038/nrmicro1557
36. Rizvi SG, Ahammad SZ. COVID-19 and antimicrobial resistance: A cross-study. Sci Total Environ. 2021; 807(2):150873. doi:10.1016/j.scitotenv.2021.150873
37. Tomczyk S, Taylor A, Brown A, de Kraker M, El-Saed A, Alshamrani M, et al. Impact of the COVID-19 pandemic on the surveillance, prevention and control of antimicrobial resistance: a global survey. J Antimicrob Chemother. 2021;76(11):3045-3058. doi:10.1093/jac/dkab300
38. Hirabayashi A, Kajihara T, Yahara K, Shibayama K, Sugai M. Impact of the COVID-19 pandemic on the surveillance of antimicrobial resistance. J Hosp Infect. 2021;117:147-156. doi:10.1016/j.jhin.2021.09.011
39. McNeil JC, Flores AR, Kaplan SL, Hulten KG. The indirect impact of the SARS-CoV-2 pandemic on invasive group A Streptococcus, Streptococcus Pneumoniae and Staphylococcus Aureus infections in Houston area children. Pediatr Infect Dis J. 2021;40(8):e313–e316 doi: 10.1097/INF.0000000000003195.
Published
2021/12/28
Section
Reviews