This scoping review provides new evidence on the prevalence and patterns of global antimicrobial use in the treatment of COVID-19 patients; identifies the most commonly used antibiotics and clinical scenarios associated with antibiotic prescribing in the first phase of the pandemic; and explores the impact of documented antibiotic prescribing on treatment outcomes in COVID-19 patients. The review complies with PRISMA guidelines for Scoping Reviews and the protocol is registered with the Open Science Framework. In the first six months of the pandemic, there was a similar mean antibiotic prescribing rate between patients with severe or critical illness (75.4%) and patients with mild or moderate illness (75.1%). The proportion of patients prescribed antibiotics without clinical justification was 51.5% vs. 41.9% for patients with mild or moderate illness and those with severe or critical illness. Comparison of patients who were provided antibiotics with a clinical justification with those who were given antibiotics without clinical justification showed lower mortality rates (9.5% vs. 13.1%), higher discharge rates (80.9% vs. 69.3%), and shorter length of hospital stay (9.3 days vs. 12.2 days). In the first 6 months of the pandemic, antibiotics were prescribed for COVID-19 patients regardless of severity of illness. A large proportion of antibiotic prescribing for mild and moderate COVID-19 patients did not have clinical evidence of a bacterial co-infection. Antibiotics may not be beneficial to COVID-19 patients without clinical evidence of a bacterial co-infection.
Bibliographical noteFunding Information:
The authors acknowledge MRC & Newton Fund support through a UK-China AMR Partnership Hub award (MR/S013717/1) and National Natural Science Foundation of China (NSFC) (81861138050). Acknowledgments: We would like to acknowledge Paul Little (School of Medicine, University of Southampton, Southampton, UK) and Bo Zheng (Institute of Clinical Pharmacology, Peking University First Hospital, Beijing, China) for their contributions to reviewing and refining the clinical justifications on antibiotic prescribing scenarios of hospitalized COVID-19 patients in this review.
Funding: The authors acknowledge MRC & Newton Fund support through a UK-China AMR Partnership Hub award (MR/S013717/1) and National Natural Science Foundation of China (NSFC) (81861138050).
© 2021 by the authors. Licensee MDPI, Basel, Switzerland.
- COVID-19 patients
- disease severity
- antibiotic use
- clinical justification
- secondary infections