Initial Empirical Antibiotic Treatment in Patients with COVID-19 is Associated with Excess Adverse Drug Reactions Without Clinical Benefit

Overview

Journal Turk J Pharm Sci

Date 2025 Jan 13

PMID 39801000

Authors

Pinar Bakir Ekinci

Emre Kara

Gulcin Telli Dizman

Meliha Cagla Sonmezer

Ahmet Cagkan Inkaya

Kutay Demirkan

Serhat Unal

Omrum Uzun

Affiliations

Soon will be listed here.

Abstract

Objectives: Empirical antibiotic use is common among hospitalized patients with coronavirus disease-2019 (COVID-19) pneumonia because it is difficult to differentiate it from concurrent bacterial pneumonia. The aim of this study was to determine risk factors for concurrent bacterial community-acquired pneumonia (b-CAP) and the need for initial empirical antibiotic coverage in patients with pulmonary involvement caused by Severe acute respiratory syndrome-Coronavirus-2 (SARS-CoV-2) infection.

Materials And Methods: This prospective observational study was conducted at a tertiary university hospital between March 2020 and April 2021. Patients aged over 18 years who were hospitalized due to COVID-19 were included. Risk factors and outcomes were compared between patients who initially received empirical antibiotics and those who did not.

Results: The presence of respiratory viral pathogens other than SARS-CoV-2 was investigated respiratory panel multiplex polymerase chain reaction in 295 patients and potential bacterial respiratory pathogens in 306 patients admitted to the hospital. The co-infection rate was low (17.4%) and half of the patients (205/409, 50.1%) were administered initial empirical antibiotics for suspected concurrent b-CAP. Antibiotic use was higher in patients with multiple comorbidities, severe to critical pneumonia, and patients older than 65 years ( < 0.001). The overall 30-day mortality rate was significantly higher (26.3% and 2.0%, < 0.001), and the duration of hospital stay was longer (median 13.0 and 5.5 days, < 0.001) in patients who received empirical antibacterial agents compared to those who did not.

Conclusion: Initial empirical antibiotic treatment is common among patients infected with SARS-CoV-2, although the coinfection rate is low. Empirical antibiotic(s) did not improve the clinical course in COVID-19 patients.

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