Antibiotic prescribing in patients with COVID-19: rapid

review and meta-analysis

pubmed.ncbi.nlm.nih.gov/33418017

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Abstract
Background: The proportion of patients infected with SARS-CoV-2 that are prescribed
antibiotics is uncertain, and may contribute to patient harm and global antibiotic resistance.

Objective: The aim was to estimate the prevalence and associated factors of antibiotic
prescribing in patients with COVID-19.

Data sources: We searched MEDLINE, OVID Epub and EMBASE for published literature
on human subjects in English up to June 9 2020.

Study eligibility criteria: We included randomized controlled trials; cohort studies; case
series with ≥10 patients; and experimental or observational design that evaluated antibiotic
prescribing.

Participants: The study participants were patients with laboratory-confirmed SARS-CoV-2

infection, across all healthcare settings (hospital and community) and age groups (paediatric
and adult).

Methods: The main outcome of interest was proportion of COVID-19 patients prescribed an
antibiotic, stratified by geographical region, severity of illness and age. We pooled proportion
data using random effects meta-analysis.

Results: We screened 7469 studies, from which 154 were included in the final analysis.
Antibiotic data were available from 30 623 patients. The prevalence of antibiotic prescribing
was 74.6% (95% CI 68.3-80.0%). On univariable meta-regression, antibiotic prescribing was
lower in children (prescribing prevalence odds ratio (OR) 0.10, 95% CI 0.03-0.33) compared
with adults. Antibiotic prescribing was higher with increasing patient age (OR 1.45 per 10
year increase, 95% CI 1.18-1.77) and higher with increasing proportion of patients requiring
mechanical ventilation (OR 1.33 per 10% increase, 95% CI 1.15-1.54). Estimated bacterial co-
infection was 8.6% (95% CI 4.7-15.2%) from 31 studies.

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Conclusions: Three-quarters of patients with COVID-19 receive antibiotics, prescribing is
significantly higher than the estimated prevalence of bacterial co-infection. Unnecessary
antibiotic use is likely to be high in patients with COVID-19.

Keywords: Antibiotic Prescribing; Antibiotics; Antimicrobial Stewardship; Antimicrobial

therapy; COVID-19; SARS-CoV-2.

Crown Copyright © 2021. Published by Elsevier Ltd. All rights reserved.

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