Antibiotics are being prescribed to prevent secondary bacterial infection because COVID-19 itself is an immunocompromised state and almost every COVID-19 sick patient is getting steroids which can further suppress immunity increasing the chances of secondary bacterial infection.
Facts:
1. Antibiotics cannot kill viruses, so they are not the definite treatment for viral pneumonia.
2. Antibiotics can kill normal bacterial flora in our body and then in such ‘immunocompromised state’ opportunistic microbes can take their place.
3. A retrospective small scale cohort study hypothesized that it’s ‘clinician’s anxiety’ over the possibility of concurrent or developing bacterial respiratory tract infections driving them to use antibiotics in cases of viral pneumonias.
Pitfalls of this study were, its small scale and retrospective nature. (Infect Control Hosp Epidemiol. 2010 November; 31(11): 1177–1183).
4. A study published in 2019 concluded that microbiota i.e., normal gut microbial flora drives an interferon (IFN) signature in lung stroma cells. These increased IFN signature impedes early influenza virus replication in lung epithelia. But the use of antibiotics reduces the IFN signature and facilitate early virus replication. (Bradley et al., 2019, Cell Reports 28, 245–256).
5. Even there is no data which shows that acute high doses of steroid use are associated with increase risk of bacterial infections.
Gibbs RC et al studied influence of prophylactic use of antibiotics on the incidence of staphylococcic infection in patients treated with steroids in the dermatological wards. They concluded that prophylactic addition of antibiotics certainly does not always succeed in preventing infection and may, in some cases, convert a potential hazard into reality. (JAMA. 1960;172(1):11-12. doi:10.1001/jama.1960)
RCTs of corticosteroid use in rheumatic diseases have not reported an increased risk of infection but observational studies have found a consistently elevated risk of infections (both serious and opportunistic). Of course, RCTs are considered more reliable when one has to draw some conclusion. (Rheum Dis Clin North Am. 2016 February; 42(1): 157–176.)
So, its time to re-think on extensive empirical antibiotics use.
Hello Prashant Wankhade
Minimal knowledge about COVID-19 and the pressure to help patients while they awaited test results led many providers to administer antibiotics early in the pandemic.
Over half of hospitalized COVID-19 patients received antibiotics in the early months of the pandemic, though only a fraction of them had bacterial infections. Nearly all antibiotics were initially administered within 48 hours of patients' admissions, when infection status is typically unknown.
Antibiotics rarely help COVID-19 patients and yet they are still being prescribed.
Antibiotic overuse is the biggest cause of antimicrobial resistance because it helps the bacteria develop resistance to the medications, while pharmaceutical development of new antibiotics has slowed which is frightening.
Please refer to the link below for more information on the topic.
https://www.medpagetoday.com/infectiousdisease/publichealth/91559
Best Wishes.
It's definitely time to rethink the automatic prescription of antibiotics.
The 'black fungus' story is another that might be related.
https://www.reuters.com/world/india/black-fungus-complication-adds-indias-covid-woes-2021-05-10/
Antibiotics need to be consume only when advised. Unnecessary consumption of it are dangerous (harmful) to human body.
Taking antibiotics when they are not needed increases the risk of getting an infection later that resists antibiotic treatment.
Think before use.
Prashant,
I have never heard of any school of medicine where use not only of antibiotics but of any agent is advised blindly to anybody presenting a set of symptoms or some approximate diagnostics. Or, maybe, there are such circumstances, like that all travellers going to India get a cocktail of 3-4 vaccines or ant malaria agents... But still, the question is one other.
On the contrary, there is a blind recommendation that the antibiotics should NOT BE USED for any viral infections if some additional indications are not present.
My question is whether this advice was falsely interpreted as a blind ban of the antibiotics that produced then very high mortality in the groups that were not considered with more attention and that SHOULD HAVE HAD antibiotics.
Some evidence shows that more than 50% of the ICU patients that died had a pulmonary bacterial superinfection. I witnessed that many patients, that had the chronic obstructive pulmonary disease (COPD) often did NOT get antibiotics preventively. On the other hand, the reports of fungal superinfections are very high so the undesirable effects may be also the problem. It is certainly very frequent that the aggressively ventilated patients often have all those infections and it is hard to distinguish the causal chain.
Still, my question was and is whether the routine order in the form “viral infection should not be treated with antibiotics” produced a disaster during the Cvid-19 pandemic.
See the thread here:
https://www.researchgate.net/post/Do-the-covid-19-patients-receive-antibiotisc#view=60a54edf90d22c4c135aaacc
Antibiotics do not work against viruses. Some people who become ill with COVID-19 can also develop a bacterial infection as a complication. In this case, antibiotics may be recommended by a health care provider. Because the misuse and abuse of these antibiotics may lead to the emergence of new strains of bacteria resistant to them. Antimicrobial resistance is not just an existential threat, it is another global pandemic with millions of antibiotic-resistant infections and more than 700 000 deaths each year.
https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/myth-busters
https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(20)30444-7/fulltext
https://www.downtoearth.org.in/blog/health/covid-19-indiscriminate-use-of-azithromycin-may-cause-more-harm-than-good-70927
Antibiotics should never be prescribed automatically.
However, distinguishing secondary bacterial infection from uncomplicated severe COVID-19 is very difficult.