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Review
. 2021 Apr;27(4):520-531.
doi: 10.1016/j.cmi.2020.12.018. Epub 2021 Jan 5.

Antibiotic prescribing in patients with COVID-19: rapid review and meta-analysis

Bradley J Langford  1 , Miranda So  2 , Sumit Raybardhan  3 , Valerie Leung  4 , Jean-Paul R Soucy  5 , Duncan Westwood  6 , Nick Daneman  7 , Derek R MacFadden  8
Affiliations
Review

Antibiotic prescribing in patients with COVID-19: rapid review and meta-analysis

Bradley J Langford et al. Clin Microbiol Infect. 2021 Apr.

Abstract

Background: The proportion of patients infected with SARS-CoV-2 that are prescribed antibiotics is uncertain, and may contribute to patient harm and global antibiotic resistance.

Objective: The aim was to estimate the prevalence and associated factors of antibiotic prescribing in patients with COVID-19.

Data sources: We searched MEDLINE, OVID Epub and EMBASE for published literature on human subjects in English up to June 9 2020.

Study eligibility criteria: We included randomized controlled trials; cohort studies; case series with ≥10 patients; and experimental or observational design that evaluated antibiotic prescribing.

Participants: The study participants were patients with laboratory-confirmed SARS-CoV-2 infection, across all healthcare settings (hospital and community) and age groups (paediatric and adult).

Methods: The main outcome of interest was proportion of COVID-19 patients prescribed an antibiotic, stratified by geographical region, severity of illness and age. We pooled proportion data using random effects meta-analysis.

Results: We screened 7469 studies, from which 154 were included in the final analysis. Antibiotic data were available from 30 623 patients. The prevalence of antibiotic prescribing was 74.6% (95% CI 68.3-80.0%). On univariable meta-regression, antibiotic prescribing was lower in children (prescribing prevalence odds ratio (OR) 0.10, 95% CI 0.03-0.33) compared with adults. Antibiotic prescribing was higher with increasing patient age (OR 1.45 per 10 year increase, 95% CI 1.18-1.77) and higher with increasing proportion of patients requiring mechanical ventilation (OR 1.33 per 10% increase, 95% CI 1.15-1.54). Estimated bacterial co-infection was 8.6% (95% CI 4.7-15.2%) from 31 studies.

Conclusions: Three-quarters of patients with COVID-19 receive antibiotics, prescribing is significantly higher than the estimated prevalence of bacterial co-infection. Unnecessary antibiotic use is likely to be high in patients with COVID-19.

Keywords: Antibiotic Prescribing; Antibiotics; Antimicrobial Stewardship; Antimicrobial therapy; COVID-19; SARS-CoV-2.

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Figures

Fig. 1
Fig. 1
Study flow diagram.
Fig. 2
Fig. 2
Classes of antibiotic prescribing in patients with COVID-19 by region. BLI, β-lactamase inhibitor. One course of polymyxins was prescribed in China.
Fig. 3
Fig. 3
Antibiotic prescribing in patients with COVID-19 by region.
Fig. 4
Fig. 4
Antibiotic prescribing in patients with COVID-19 by age group.
Fig. 5
Fig. 5
Antibiotic prescribing in patients with COVID-19 by healthcare setting.
Fig. 6
Fig. 6
Antibiotic prescribing in patients with COVID-19 by study quartile of proportion of patients requiring mechanical ventilation.
Fig. 7
Fig. 7
Antibiotic prescribing in patients with COVID-19 by study end date.
See this image and copyright information in PMC

References

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