Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2021;4(3):503-513.
doi: 10.1007/s42398-021-00194-6. Epub 2021 Jun 7.

Antibacterial agents used in COVID-19: A systematic review and meta-analysis

Swati Sharma  1 , Aradhana Singh  1 , Tuhina Banerjee  1
Affiliations
Review

Antibacterial agents used in COVID-19: A systematic review and meta-analysis

Swati Sharma et al. Environ Sustain (Singap). 2021.

Abstract

There have been speculations regarding rise in antimicrobial resistance (AMR) globally owing to indiscriminate antibiotic usage during the COVID-19 pandemic. To curb the menace through decisive policies, it is essential to assess the antibiotics, particularly the antibacterial agents. This systematic review and meta-analysis were performed to assess antibiotic use in COVID-19 patients. A thorough systematic search was undertaken in databases like PubMed, Cochrane library, Google Scholar, World Health Organization (WHO) database and clinicaltrials.gov by two independent reviewers for articles in English published from January 1, 2019 to October 31, 2020. Studies were included if they assessed confirmed COVID-19 cases and mentioned the use of antibiotics. The primary outcome was the proportion of COVID-19 patients subjected to specific antibacterial agents. An attempt to stratify the data based on study settings and disease severity was also performed. Of the total 6012 studies screened, 40 were eligible for qualitative review and 19 for meta-analysis. Specific antibacterial agents were mentioned in 23 studies (57.5%). In the random effect meta-analysis, pooled prevalence of azithromycin use was 24.5% (95% CI 22.9-26.2%) followed by cephalosporins as 26.6% (95% CI 24.9-28.4). None of the studies clearly specified indications for antibiotic use. Ten studies (25%) mentioned empirical use of antibiotics. Bacterial co-infections/secondary infections were documented in four studies with mean prevalence of infection of 1.9% (95% CI 1.2-2.8%). There is lack of data on use of specific antibacterial agents, indications for their use based on severity of infections and microbiological evidence of bacterial co-infections.

Keywords: Antibiotics; Antimicrobial resistance; Azithromycin; Bacterial co-infections; COVID-19; Cephalosporins; Empirical.

PubMed Disclaimer

Conflict of interest statement

Conflict of interestAll authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Study flow diagram based on PRISMA guidelines
Fig. 2
Fig. 2
Distribution of selected articles across the globe
Fig. 3
Fig. 3
Forest plots showing pooled prevalence of individual antibacterial agents
Fig. 4
Fig. 4
Forest plots showing empirical antibiotic use and documented bacterial co-infections in COVID-19 patients
Fig. 5
Fig. 5
Funnel plots showing assessment of publication bias for individual antibacterial agents
See this image and copyright information in PMC

References

    1. Abd-Elsalam S, Esmail ES, Khalaf M, Abdo EF, Medhat MA, Abd El Ghafar MS, Ahmed OA, Soliman S et al (2020) Hydroxychloroquine in the treatment of COVID-19: a multicenter randomized controlled study. Am J Trop Med Hyg 103:1635–1639 - PMC - PubMed
    1. An MH, Kim MS, Kim BO, Kang SH, Kimn WJ, Park SK, Park HW, Yang W et al (2020) Treatment response to hydroxychloroquine and antibiotics for mild to moderate COVID-19: a retrospective cohort study from South Korea. medRxiv. 10.1101/2020.07.04.20146548
    1. Angus DC, Berry S, Lewis RJ, Al-Beidh F, Arabi Y, van Bentum-Puijk W, Bhimani Z, Bonten M et al (2020) The REMAP-CAP (randomized embedded multifactorial adaptive platform for community-acquired pneumonia) study. Rationale and design. Ann Am Thorac Soc 17:879–891 - PMC - PubMed
    1. Banerjee T, Anupurba S, Singh DK (2013) Poor compliance with the antibiotic policy in the intensive care unit (ICU) of a tertiary care hospital in India. J Infect Dev Ctries 15:7 - PubMed
    1. Banerjee T, Mishra A, Das A, Sharma S, Barman H, Yadav G (2018) High prevalence and endemicity of multidrug resistant Acinetobacter spp. in intensive care unit of a Tertiary Care Hospital, Varanasi, India. J Pathog 2018:9129083 - PMC - PubMed

LinkOut - more resources