Antimicrobial prescribing in SARS-CoV-2

The last research roundup provided a review some disparate prescribing issues that have arisen and been reviewed due to the current pandemic. One of those articles reviewed was the trend in out of hour antibiotic prescribing before and during the COVID-19 pandemic. This month we will follow up with a review of antimicrobial prescribing practices in patients being treated for SARS-CoV-2 either the use of these for COVID-19 itself or for detected secondary infection.

In this article by Stevens et al (2020) we start to see some early evidence looking at the rate and spectrum of antibiotic prescribing being collected in a single centre study. This study was a retrospective review of data of local patients diagnosed with COVID-19 at a large, academic, tertiary-care treatment centre and included all inpatient, emergency department (ED), or outpatient encounters of patients with confirmed COVID-19 infection to analyse the prevalence, number of agents, spectrum of activity, and duration of antimicrobial therapy. Only adult patients' records were reviewed and those who have had COVID-19 confirmed by PCR test. The records reviewed spanned the period between 1st March and 29th April 2020 leading to 346 patient records meeting inclusion criteria to be studied. Across the entire cohort, 10% of patients received antimicrobial therapy for a mean duration of 5.7 days. Antimicrobials were administered in 59% of all inpatients with rates of 29%, 47%, and 87% for mild, moderate, and severe cases, respectively. Prescribing rate, spectrum, and duration appeared to increase with disease severity in inpatients. Antimicrobial prescribing in patients managed in ambulatory and outpatient settings was less common.