The Use of Antibiotic in COVID Patients

COVID-19 is an infectious disease that is typically defined as an illness caused by a novel coronavirus also called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; formerly named 2019-nCoV). The disease was first detected amid an outbreak of respiratory illness cases in Wuhan City, Hubei Province, China. It was first reported to the specialized agency of the UN responsible for international public health on December 31, 2019. On January 30, 2020, the agency proclaimed that the COVID-19 outbreak is a global health emergency. On March 11, 2020, the agency proclaimed that COVID-19 is a global pandemic.

The significant role of antibiotics in the treatment of SARS-CoV-2 cases has not yet been adequately specified, and no criteria have been confirmed for antibiotic treatment, type, and time span.

What are Antibiotics:
Antibiotics have saved millions of lives since they came into widespread use, but excess use accelerates the evolution of bacterial resistance to medicines. Antibiotics are common medicines widely used for the treatment of bacterial infections. Although, as per certain recent laboratory studies, some antibiotics decelerated the replication of some viruses, including SARS-CoV-2 (Severe acute respiratory syndrome coronavirus 2), the virus that is responsible for causing COVID-19.

In laboratory tests, an antibiotic named azithromycin, scaled-down viral activity and inflammation, and so it has been evaluated as a potential treatment for COVID-19.
The community also needs to be aware that excessive use or misuse of antibiotics can lead to antimicrobial resistance, where organisms that cause infection change so that antibiotics stop working.

Types of Antibiotics Used in the Management of COVID-19 Patients: The use of antibiotics among COVID-19 patients is high but there are limited studies in this context:

• Cephalosporins
• Ceftriaxone
• Cefepime Sulbactum
• Cefoperazone Sulbactum
• Cefixime
• Macrolides
• Azithromycin
• Erythromycin
• Clindamycin
• Penicillins
• Piperacillin Tazobactum
• Amoxicillin Clavulanic acid
• Quinolones

Potential Treatments for COVID-19:
Initially in the pandemic, there were no determined therapeutic interventions. At that juncture, antiviral medications such as lopinavir/ritonavir, remdesivir; antimalarials (chloroquine or hydroxychloroquine); interferons; convalescent plasma; and ivermectin were used. In spite of this, today there is some deets and evidence against its application, even demonstrating deleterious effects. Therefore, in addition to symptomatic treatment, several options have been proposed for the most critical phases of the disease.

Recently, targeted antiviral therapy (molnupiravir, paxlovid) and anti-SARS-CoV-2 monoclonal antibodies (bamlanivimab and etesevimab, casirivimab and imdevimab) have been approved under Food and Drug Administration issued Emergency Use Authorization (EUA). Although, they do not scale down mortality.

A randomized assessment of COVID-19 Therapy (RECOVERY) study demonstrated that when using a drug named dexamethasone, there was a notable reduction in 28-day mortality in severely ill patients with SARS-CoV-2 and a less oxygen requirement, mainly invasive mechanical ventilation (IMV).

Furthermore, as per the retrospective cohort, the likelihood of occurring secondary infection was not typically affected by the use of corticosteroids, and this was held persistent in the sub-analysis examining blood, urine, and sputum cultures in order to prove any signs and symptoms of bacterial infection; concluding that the diagnosis of bacterial superinfection did not have an impact on the possibility of mortality in 28 days.

Tocilizumab is another endorsed medicine. It is an IL-6 inhibitor, which reduces mortality and invasive mechanical ventilation requirements without increasing serious side effects. Although, according to a single-center cohort, administration of tocilizumab was related to a higher proportion of bacterial superinfection; no difference in the 28-day case fatality rate among patients treated with tocilizumab who established bacterial superinfection.

Statistics:

In the UK, the National Institute for Health and Care Excellence (NICE) reports that under 8% of patients hospitalized with CORONAVIRUS Disease also have a bacterial infection. But as per one study in the UK, an estimated 85% of COVID-19 patients receive treatment with an antibiotic during hospitalization.

Reference:
https://www.medscape.com/viewarticle/961046
https://journals.asm.org/doi/10.1128/AAC.01341-21?cookieSet=1
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9297358/
https://www.cureus.com/articles/106827-when-to-use-antibiotics-in-covid-19-a-proposal-based-on-questions