Table 5.2.
Summarized Evidence-Based Recommendations for Antibacterial Therapy in Adults With COVID-19 (Sieswerda et al., 2020).
| Recommendation | Strength | Quality of Evidence |
|---|---|---|
| Antibacterial drugs should be restricted in suspected or confirmed COVID-19 patients. This especially applies for mild and moderated cases. | Weak | Very low |
| Exceptions for the restrictive use of antibacterial drugs can be made for suspected or confirmed COVID-19 patients presenting with radiological findings and/or inflammatory markers compatible with bacterial coinfection, immunocompromised cases,a and those with severe illness. | Weak | GPS |
| Blood, sputum, and pneumococcal urinary antigen testing is better done upon admission before the start of empirical antibiotic therapy in suspected or confirmed COVID-19 patients. | Strong | GPS |
| In case of suspected bacterial coinfection, empirical antibiotic treatment covering atypical pathogens is better avoided in suspected or confirmed COVID-19 patients hospitalized at the general ward. Legionella urinary antigen testing should be performed according to local and/or national guidelines for CAP. | Weak | Very low |
| The empirical antibiotic regimens in case of suspected bacterial coinfection depend on the severity of disease and according to local and/or national guidelines. For those fulfilling criteria of mild and moderate severe CAP, following local and/or national guideline recommendations on antibacterial treatment in CAP is recommended. | Weak | Very low |
| Following local and/or national guideline recommendations on antibacterial treatment for patients with COVID-19 and suspected bacterial secondary infection is recommended. | Strong | GPS |
| Stopping antibiotics is suggested when blood, sputum, and urinary antigen tests taken before start of empirical antibiotic therapy in patients with suspected or confirmed COVID-19 show no bacterial pathogens after 48 h of incubation. | Weak | GPS |
| Antibiotic treatment for 5 days is suggested in patients with COVID-19 and suspected bacterial infection upon improvement of signs, symptoms, and inflammatory markers. | Weak | GPS |
a
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.