Version 1: 19-03-2020

Initial empiric antibiotics

  • COVID-19 itself is not an indication for antibiotics.

  • There may be concerns regarding superimposed bacterial pneumonia.  

    • If in doubt, obtain bacterial cultures and procalcitonin, prior to initiation of empiric antibiotic therapy. 

    • Based on results, antibiotics may be discontinued in <48 hours if there isn't evidence of a bacterial infection (this is exactly the same management as influenza pneumonia).

Delayed bacterial superinfection [1]

·       Bacterial pneumonia can emerge during the hospital course (especially ventilator-associated pneumonia in patients who are intubated).

·       Among patients who died from COVID-19, one series found that 11/68 (16%) had secondary infections [2].

·       This may be investigated and treated similarly to other ventilator-associated pneumonias, or hospital-acquired pneumonias.

 

Empiric antimicrobials should be given to treat all likely pathogens causing SARI and sepsis as soon as possible, within 1 hour of initial assessment for patients with sepsis. [3]

  • Remark 1: Although the patient may be suspected to have COVID-19, administer appropriate empiric antimicrobials within 1 hour of identification of sepsis [4]. Empiric antibiotic treatment should be based on the clinical diagnosis (community-acquired pneumonia, health care-associated pneumonia [if infection was acquired in health care setting] or sepsis), local epidemiology and susceptibility data, and national treatment guidelines. 

  • Remark 2: When there is ongoing local circulation of seasonal influenza, empiric therapy with a neuraminidase inhibitor should be considered for the treatment for patients with influenza or at risk for severe disease [4]. 

Empiric therapy should be de-escalated on the basis of microbiology results and clinical judgment.

References: 

(1) Josh Farkas. COVID-19. The Internet Book of Critical Care. https://emcrit.org/ibcc/covid19/

(2) Ruan, Q., Yang, K., Wang, W. et al. Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China. Intensive Care Med (2020). https://doi.org/10.1007/s00134-020-05991-x

(3) World Health Organization. Clinical management of severe acute respiratory infection (SARI) when COVID19 disease is suspected. Geneva: World Health Organization; 2020 (accessed 16 March 2020). 

(4) Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Intensive Care Med. 2017;43(3):304-77. Epub 2017/01/20. doi: 10.1007/s00134-017-4683-6. PubMed PMID: 28101605.

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