Use of antibiotics in hospitalized patients with COVID-19: evolving concepts in a highly dynamic antimicrobial stewardship scenario

ABSTRACT

Introduction

Excessive use of antibiotics has been frequently reported in hospitalized patients with COVID-19 worldwide, compared to the actual number of bacterial co-infections or super-infections.

Areas covered

In this perspective, we discuss the current literature on the use of antibiotics and antimicrobial stewardship interventions in hospitalized patients with COVID-19. A search was conducted in PubMed up to March 2023.

Expert opinion

The COVID-19 pandemic has witnessed an excessive use of antibiotics in hospitals worldwide, especially before the advent of COVID-19 vaccination, although according to the most recent data there is still an important disproportion between the prevalence of antibiotic use and that of proven bacterial coinfection or superinfections. An important reduction in the prevalence of antibiotic use in COVID-19 patients reported in the literature, from 70–100% to 50–60%, has been observed after successful vaccination campaigns, likely related to the reduced median disease severity of hospitalized COVID-19 patients and some successful interventions of antimicrobial and diagnostic stewardship. However, the disproportion between antibiotic use and the prevalence of bacterial infections (4–6%) is still uncomfortable from an antimicrobial stewardship perspective and requires further attention.

KEYWORDS:

• Antimicrobial stewardship
• COVID-19
• antibiotics
• co-infections
• super-infections
• antimicrobial resistance

Article highlights

• An excessive use of antibiotics has been frequently reported in hospitalized patients with COVID-19 worldwide, compared to the actual number of bacterial co-infections or super-infections

• Recently, an important reduction in the prevalence of antibiotic use in COVID-19 patients reported in the literature, from 70–100% to 50–60%, has been observed

• This reduction may be related to the reduced median disease severity of hospitalized COVID-19 patients and some successful interventions of antimicrobial and diagnostic stewardship

• However, the disproportion between antibiotic use and the prevalence of bacterial infections (4–6%) is still uncomfortable from an antimicrobial stewardship perspective

• Rapid diagnostic tests have the potential to improve appropriateness of early antibiotic change, initiation, or discontinuation in COVID-19 patients, although further research is needed

Declaration of interest

Outside the submitted work, M Bassetti has received funding for scientific advisory boards, travel, and speaker honoraria from Angelini, Astellas, BioMérieux, Cidara, Gilead, Menarini, MSD, Pfizer, Shionogi, Tetraphase, and Nabriva. Outside the submitted work, D R Giacobbe reports investigator-initiated grants from Pfizer, Shionogi, and Gilead Italia, and speaker/advisor fees from Pfizer and Tillotts Pharma.

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.