The British Society for Antimicrobial Chemotherapy (BSAC) has published guidance on antibiotic prescribing in the context of the COVID-19 pandemic.
The pandemic challenges both recognition and management of serious acute bacterial infection and effective delivery of antimicrobial stewardship, wrote Dr RA Seaton, NHS Consultant in Infectious Diseases, and BSAC OPAT initiative co-lead.
“Serious bacterial infections may be missed when all attention focuses on COVID-19. It is therefore important to consider (investigate and empirically treat) bacterial infection when assessing the febrile patient and particularly those who have self-isolated at home,” he said.
"'Start smart then focus' principles apply in those who have commenced antibiotics. Review the diagnosis and management plan as more clinical information becomes available and ideally at 48-72 hours; ensure antibiotic duration is short as possible and as per local guidance, and in those receiving IV antibiotics consider IV to oral switch daily," Dr Seaton said.
"Ambulatory management in those with bacterial infection requiring ongoing IV or complex oral therapies should be maximised via referral to OPAT or COPAT (complex outpatient antibiotic therapy) services in order to minimise COVID-19 transmission risk to vulnerable patients," he added.
"Although COVID-19 is a viral infection there are overlapping clinical and radiological features with bacterial respiratory tract infection so antibiotics will be prescribed for many patients," said Dr Seaton.
"Stewardship teams have a role in limiting antibiotic prescribing in suspected or proven COVID-19 infection," he said.
“Consider antibiotics in those where bacterial infection cannot be excluded, eg, COPD exacerbations with purulent sputum or when radiological evidence of pneumonia. CRP is usually raised in COVID-19 and does not predict bacterial co-infection. Promote local infection management guidelines, remember IVOST when clinical improvement and limit duration to five days for the majority of respiratory indications. Remember drug interactions/toxicity: QTc prolongation (macrolides, quinolones), cation drug interactions (doxycycline, quinolones) and other drug interactions (macrolides, quinolones).”