Q&A: Antibiotic overprescribing intensifies during COVID-19 pandemic
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The CDC previously reported that about one-third antibiotic prescriptions in the United States are unnecessary. New data suggest that efforts to curb antibiotic overprescribing have taken a step backward during the COVID-19 pandemic, according to the Society for Healthcare Epidemiology of America.
“We know COVID-19 is a viral pneumonia,” Trevor Van Schooneveld, MD, director of the antimicrobial stewardship program at the Nebraska Medical Center, told Healio Primary Care. “But if we diagnose a viral pneumonia, we don’t need antibiotics.”
Van Schooneveld, a SHEA board member, discussed the new findings and the importance of antibiotic stewardship during the pandemic. – by Janel Miller
Q: What recent data suggest that the rate of antibiotic overprescribing has increased because of COVID-19? What do the findings show us?
A: There are two recent papers that looked at bacterial coinfection and antibiotic use in patients with COVID-19. They found bacterial infection was uncommon but upwards of 80% to 100% of patients in some locations received antibiotics. National data is currently hard to come by.
Q: The misuse of antibiotics has been problematic for a long time now. What is behind the upswing during this pandemic?
A: We want to do something to try to make people better. This is the same thing that drives the use of hydroxychloroquine. And just as we see that the use of hydroxychloroquine and chloroquine might be bad for patients, treating viral infections with antibiotics is not helpful and much more likely to be harmful..
Q: What are the immediate and long-term consequences of antibiotic overprescribing?
A: In the short term, patients might develop allergic reactions, toxicities, diarrhea and kidney problems. Long term, patients with COVID-19 who receive unneeded antibiotics, if they do develop an infection, are more likely to have an infection that is resistant to antibiotics. The development of antimicrobial resistance with unneeded antibiotic use hasn’t gone away because of COVID-19.
Q: Can some antibiotic overprescribing be forgiven in a situation like this?
A: In the early days of the pandemic, we were sorting things out a little bit. But over the last couple of months, it has become pretty clear that COVID-19 is a viral pneumonia and bacterial coinfection is uncommon. Unless there’s something funny going on, usually we don’t need to prescribe antibiotics.
Q: What is your message for clinicians who may be prescribing antibiotics to patients with clearly defined viral pneumonia related to COVID-19?
A: The same message that we’ve been saying for a long time: Antibiotics don’t make viral infections better. In this situation, antibiotics are not going to benefit your patient and they’re probably going to harm your patient.
References:
Clancy CJ, Nguyen MH. Clin Inf Dis. 2020;doi:10.1093/cid/ciaa524.
Rawson TM, et al. Clin Infect Dis. 2020;doi:10.1093/cid/ciaa530.
Disclosure: Van Schooneveld reports no relevant financial disclosures.