Table 2.
Summary of recommendations
| Recommendation | Strength | Quality of evidence |
|---|---|---|
| 1. We generally suggest restrictive use of antibacterial drugs in patients with proven or a high likelihood of COVID-19. This especially applies for patients upon admission who are mild to moderately ill | Weak | Very low |
| 2. We suggest that exceptions for the restrictive use of antibacterial drugs can be made for patients with proven or a high likelihood of COVID-19 who present with radiological findings and/or inflammatory markers compatible with bacterial co-infection. Other exceptions are patients who are severely ill or immunocompromised∗ | Weak | GPS |
| 3. We recommend maximum efforts to obtain sputum and blood for culture as well as pneumococcal urinary antigen testing before start of empirical antibiotic therapy in patients with proven or high likelihood of COVID-19 upon admission | Strong | GPS |
| 4. In case of suspected bacterial co-infection, we suggest against empirical antibiotic treatment covering atypical pathogens in patients with proven or high likelihood of COVID-19 hospitalized at the general ward. Legionella urinary antigen testing should be performed according to local and/or national guidelines for CAP | Weak | Very low |
| 5. We recommend that the empirical antibiotic regimens in case of suspected bacterial co-infection depends on the severity of disease and according to local and/or national guidelines. For those fulfilling criteria of mild and moderate-severe CAP, we recommend to follow local and/or national guideline recommendations on antibacterial treatment in CAP | Weak | Very low |
| 6. We recommend to follow local and/or national guideline recommendations on antibacterial treatment for patients with COVID-19 and suspected bacterial secondary infection | Strong | GPS |
| 7. We suggest to stop antibiotics when representative sputum and blood culture as well as urinary antigen tests taken before start of empirical antibiotic therapy in patients with proven or high likelihood of COVID-19 show no bacterial pathogens after 48 hours of incubation | Weak | GPS |
| 8. We suggest an antibiotic treatment duration of five days in patients with COVID-19 and suspected bacterial infection upon improvement of signs, symptoms and inflammatory markers | Weak | GPS |
∗
immunocompromised is defined as the use of chemotherapy for cancer, bone marrow or organ transplantation, immune deficiencies, poorly controlled HIV or AIDS, or prolonged use of corticosteroids or other immunosuppressive medications; GPS: good practice statement.