New research presented at the ESCMID Global Congress (formerly ECCMID) in Barcelona sheds light on the impact of antibiotic treatment in adults hospitalised with moderate COVID-19. The study, conducted by researchers from the University Hospital Schleswig-Holstein in Germany, highlights that antibiotic therapy, despite being administered to over 40% of patients, is associated with clinical deterioration.

The study analysed data from 1,317 hospitalised adults with confirmed SARS-CoV-2 infections between March 2020 and May 2023. Of these patients, 41% with moderate disease received antibiotics commonly used for respiratory infections. Microbiological investigations revealed that only a small fraction of patients had documented respiratory bacterial superinfection, raising concerns about the indiscriminate use of antibiotics.

Lead author Dr. Anette Friedrichs emphasises the importance of judicious antibiotic use, stating, “Antibiotic therapy should only be given for suspected or confirmed bacterial co- or superinfection in COVID-19 patients. However, the high use of antibiotics among hospitalised patients diagnosed with COVID-19, despite evidence of uncommon superinfections, exacerbates the antibiotic resistance problem.”

The study found that patients treated with antibiotics had a five-fold greater risk of clinical deterioration after 14 days compared to those not treated with antibiotics. Factors including, sex, disease severity, comorbidities, and vaccination status were associated with a higher likelihood of receiving antibiotics and experiencing worse outcomes.

Dr Friedrichs underscores the need for improved antibiotic stewardship interventions, stating, “Rational antibiotic use should be limited to patients with a likely bacterial coinfection and started only after performing the respective microbiological diagnostics. Antibiotics should be discontinued once a co-infection has been deemed unlikely.”

The study’s observational nature and its focus on patients hospitalised in Germany are acknowledged as limitations. However, the findings provide valuable insights into the potential harms of indiscriminate antibiotic use during viral pandemics like COVID-19, urging healthcare providers to adopt more cautious prescribing practices. Strengthening antibiotic stewardship programmes and enhancing diagnostic capabilities are crucial steps in combating antimicrobial resistance and improving patient outcomes in future pandemics.