Int J Antimicrob Agents. 2021 Oct 22:106462. doi: 10.1016/j.ijantimicag.2021.106462. Online ahead of print.
OBJECTIVES: The use of antibiotics was common in some countries during the early phase of COVID-19 pandemic, but adequate evaluation is so far lacking. This study aimed to evaluate the effect of early antibiotic use in non-severe COVID-19 patients admitted without bacterial infection.
METHODS: This multi-center retrospective cohort study included 1,373 non-severe COVID-19 inpatients admitted without bacterial infection. Patients were divided into two groups according to their exposure to antibiotics within 48 hours after admission. The outcomes were progressing from non-severe type COVID-19 into severe type, length of stay over 15 days, and mortality rate. Mixed-effect Cox model and random effect logistic regression were used to explore the association between early antibiotics use with outcomes.
RESULTS: During the follow-up of 30 days, the proportion of patients progressed to severe type COVID-19 in the early antibiotic use group was almost 1.4 times that of the comparison group. In the mixed-effect model, the early use of antibiotics was associated with higher probability of developing severe type and staying in the hospital for over 15 days. However, there was no significant association between early use of antibiotics and mortality. Analysis with propensity score-matched cohorts displayed similar results. In subgroup analysis, patients receiving any class of antibiotics were at increased risk for adverse health outcomes. Azithromycin did not improve the disease progression and length of stay in patients with COVID-19.
CONCLUSIONS: It is suggested that antibiotic use should be avoided unless absolutely necessary in non-severe COVID-19 patients, particularly in the early stages.