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Published on: August 30, 2018
Antibiotic prescribing in patients with COVID-19: rapid review and meta-analysis
Bradley J Langford1, Miranda So2, Sumit Raybardhan3
1Public Health Ontario, ON, Canada; Hotel Dieu Shaver Health and Rehabilitation Centre, ON, Canada.
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.
Insights
Antibiotic prescribing for COVID-19 patients is high, with 74.6% receiving them, far exceeding bacterial co-infection rates. This suggests significant unnecessary antibiotic use, contributing to antimicrobial resistance.
Area of Science:
- Infectious Diseases
- Pharmacology
- Public Health
Background:
- Antibiotic prescribing for patients with SARS-CoV-2 (COVID-19) is not well understood.
- High antibiotic use may lead to patient harm and global antimicrobial resistance.
Purpose of the Study:
- To estimate the prevalence of antibiotic prescribing in COVID-19 patients.
- To identify factors associated with antibiotic prescribing in this population.
Main Methods:
- A systematic literature search was conducted across multiple databases (MEDLINE, OVID Epub, EMBASE) up to June 9, 2020.
- Included studies were randomized controlled trials, cohort studies, case series (≥10 patients), and experimental or observational designs evaluating antibiotic prescribing in laboratory-confirmed SARS-CoV-2 infected individuals.
- A random effects meta-analysis was used to pool proportion data, stratified by region, illness severity, and age.
Main Results:
- 154 studies involving 30,623 patients were analyzed.
- The overall prevalence of antibiotic prescribing was 74.6% (95% CI 68.3-80.0%).
- Antibiotic prescribing was lower in children and increased with patient age and mechanical ventilation requirements. Estimated bacterial co-infection was 8.6% (95% CI 4.7-15.2%).
Conclusions:
- Approximately three-quarters of COVID-19 patients received antibiotics.
- Antibiotic prescribing rates significantly exceeded the estimated prevalence of bacterial co-infection.
- High rates of unnecessary antibiotic use are likely in COVID-19 patients, contributing to antimicrobial resistance concerns.
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