Community-acquired pneumonia in the COVID-19 era: guideline authors offer advice

  • Metlay JP & al.
  • Ann Intern Med
  • 7 May 2020

  • curated by Jenny Blair, MD
  • Clinical Essentials
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Takeaway

  • 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.

Description

Key details

  • 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.