- Patients with confirmed SARS-CoV-2 infection and community-acquired pneumonia (CAP) do not always require antibiotics.
- If antibiotics are started, procalcitonin may help guide discontinuation.
Why this matters
- Most COVID-19-related lung injury is thought to be caused by the virus, but concerns remain about bacterial coinfection.
- Cochairs of recent American Thoracic Society and Infectious Diseases Society of America Guideline for Treatment of Adults with Community-Acquired Pneumonia discuss how to use the guideline in COVID-19 patients.
- Empiric antibiotic coverage:
- Recommended for patients with CAP and without confirmed COVID-19.
- Not required for patients with confirmed COVID-19-related pneumonia.
- However, among patients with COVID-19 and chest radiographic abnormalities, isolated SARS-CoV-2 infection is “a largely untested hypothesis.”
- A recent series of fatal COVID-19 cases found that serologic evidence of bacterial coinfection was “not uncommon.”
- In COVID-19 patients, any bacterial copathogens are likely the same as in CAP patients.
- Thus, use same empiric antibiotics as in CAP:
- Low-risk inpatients: beta-lactam plus either macrolide or doxycycline, or monotherapy with fluoroquinolone.
- High-risk inpatients: beta-lactam plus either macrolide or fluoroquinolone.
- If covering Pseudomonas aeruginosa or methicillin-resistant Staphylococcus aureus, obtain cultures.
- Low procalcitonin and confirmed COVID-19 suggests antibiotics may be withheld or stopped early.
- Corticosteroids and immunomodulators are not recommended for COVID-19 pneumonia.