COVID-19 and antimicrobial therapy

BACKGROUND: One of the problems with managing patients with a new coronavirus infection is the irrational use of antibiotics. Antibacterial drugs are not active against viral infection, including COVID-19. Unfortunately, in actual clinical practice, the level of antibiotic use remains extremely high, reaching 70–80%. Unwanted antibacterial therapy leads to a number of undesirable phenomena that can significantly worsen the patient’s condition, and sometimes lead to life-threatening consequences. In this context, the most important question is the formulation of the diagnosis. In particular, the reference to the term “pneumonia”, in the case of COVID-19, is neither scientifically or clinically feasible. The most correct would be to call this process — viral or virus-associated lung damage. This term will allow you to set priorities in the choice of tactics leading the patient. That is, viral lesion (not pneumonia!) will induce the practical doctor to analyze the situation requiring prescription in the presence of indications of anti-inflammatory (monoclonal antibodies, glucocorticosteroids) and anticoagulation therapy, and will avoid unnecessary in the overwhelming number of antimicrobial prescription situations.

AIM: Formulate criteria for prescribing antibacterial therapy in patients with COVID-19.

MATERIALS AND METHODS: The study is based on a review and analysis of the literature on new coronavirus infection, drawing conclusions and recommendations.

RESULTS: In actual Russian practice, the level of use of antibiotics remains extremely high, reaching 70–80%.

CONCLUSION: The prescription of antibacterial therapy in patients with COVID-19 is justified only if there are convincing signs of bacterial infection — the appearance of purulent sputum, increased procalcitonin of blood more than 0,25–0.5 ng/ml, an increase in blood white count of more than 10 thousand/mcl with an increase in the number band neutrophils more than 10%.