Antibiotics seldom necessary for people with COVID-19

Disease and treatment 21. sep 2020 2 min Professor Thomas Benfield Written by Kristian Sjøgren

Danish research shows that people with COVID-19 who are hospitalized rarely have bacterial infections. Antibiotics are therefore not needed at admission, says a researcher.

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About 95% of the people hospitalized with COVID-19 are treated immediately with antibiotics. The reasons include sky-high infection biomarkers, blood test parameters that are completely skewed and X-rays seemingly indicating typical pneumonia.

However, a new Danish study shows that treating everyone with antibiotics is not necessary.

The vast majority of people hospitalized with COVID-19 in Denmark only have a viral infection. Treatment with antibiotics therefore does not help them get well – and in fact can do more harm than good.

“There are many reasons to avoid using antibiotics. It is not healthy, and we want to use antibiotics as sparingly as possible globally to avoid developing antimicrobial resistance,” says a researcher behind the study, Thomas Benfield, Professor and Chief Physician, Department of Clinical Medicine, Amager and Hvidovre Hospital, University of Copenhagen.

The research results have been published in Infectious Diseases.

No one hospitalized at Hvidovre Hospital had bacterial infection

The researchers examined data from 215 people hospitalized at Hvidovre Hospital with COVID-19 pneumonia.

On admission, everyone underwent blood culture to determine whether they had bacteria in their bloodstream. The blood culture was performed in parallel with radiological examinations of the lungs and other tests.

At the same time, doctors routinely administered antibiotics to quickly eliminate any bacterial infection.

However, the results show that the doctors could have avoided using antibiotics, because none of the 215 people hospitalized had any bacterial infection when admitted.

“We conclude that all these people only had COVID-19, so we can confirm people hospitalized with COVID-19 do not need antibiotics,” says Thomas Benfield.

The discovery has meant that Hvidovre Hospital is much more aware about only administering antibiotics until the doctors confirm solely viral infection. Then antibiotics are immediately stopped.

“We accept giving these people antibiotics because they are critically ill, but as soon as the microbiology report come back negative, we stop the antibiotics instead of continuing for several weeks, which can sometimes happen,” says Thomas Benfield.

Hospital-acquired bacterial infections

Does this finding mean that people with COVID-19 never acquire bacterial infection when hospitalized? Certainly not.

Twelve of the 215 people hospitalized (5%) acquired 17 bloodstream infections.

They did not initially have bacterial infection but acquired it in the hospital.

Thomas Benfield says that inserting an intravascular catheter or a catheter elsewhere during intensive care increases the risk of hospital-acquired bacterial infection.

“Hospital-acquired infection typically occurs in intensive care units. Further, the bacteria that cause a bloodstream infection are most often known from other hospital-acquired infections, such as staphylococci and other pathogens present in people’s own gastrointestinal system,” explains Thomas Benfield.

Although 5% of the people hospitalized with COVID-19 acquired bacterial infection in the hospital, Thomas Benfield says this is not an alarmingly high number since it roughly matches what is expected for intensive care.

Antibiotics can harm people

Thomas Benfield emphasizes that doctors should not be so eager to use antibiotics for people with COVID-19 until they are sure that these people either already have bacterial infection when admitted or acquire it while hospitalized.

The whole world is trying to limit the use of antibiotics to minimize the development of antimicrobial resistance.

Overuse of antibiotics may not harm the individual person being treated, but the next person in line may be infected with, for example, antimicrobial-resistant staphylococci, which can be life-threatening if doctors cannot figure out how to destroy it.

Further, treatment with antibiotics is not healthy for the body if it can be avoided.

Antibiotics kill not only harmful bacteria but also the body’s own bacteria on the skin or in the intestines.

Destroying these beneficial bacteria means that they can no longer protect the person against infections from other bacteria and viruses.

“Antibiotics can also have side-effects, and we therefore need to reduce their use. They promote certain types of bacteria by suppressing a person’s normal bacteria. Antibiotics must be used sensibly, and this includes not giving them to people with viral infections, who do not benefit from their use,” says Thomas Benfield.

Thomas Benfield hopes he can conduct an even larger study with more patients from across Denmark. If the results confirm the findings of this small study, they will support the recommendation that people with COVID-19 should not receive antibiotics as standard practice.

Predominance of hospital-acquired bloodstream infection in patients with Covid-19 pneumonia” has been published in Infectious Diseases. In 2018, the Novo Nordisk Foundation awarded a grant to Thomas Benfield for the project Shortened Antibiotic Treatment in Community-acquired Pneumonia: A Nationwide Danish Randomized Clinical Trial.

Professor of infectious diseases at the Department of Clinical Medicine, University of Copenhagen, and attending physician at the Department of Infect...

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