Antibiotic use in COVID-19

Antibiotic use in COVID-19


Most patients with COVID-19 have mild respiratory disease and recover with supportive care alone

Investigational antivirals and immunomodulatory treatments may be considered as part of approved clinical trials and will be assessed by an Infectious Diseases physician prior to initiation in Nova Scotia Health (NSH)


Antibiotics for bacterial pneumonia are often unnecessary in patients with COVID-19

  • The rates of bacterial pneumonia co-infections and secondary infections are low

CRP is a non-specific inflammatory marker and is often elevated in COVID-19

COVID-19 infection itself often causes persistent fever and bilateral infiltrates

Antibiotics are not benign an may result in advserse events:

  • C. difficile infection
  • Antimicrobial resistance
  • Nephrotoxicity
  • Arrhythmias

Investigations if Bacterial Co-infection is Suspected

  • Blood cultures
  • Sputum cultures in some patients
    • If ICU admission requiring intubation, concern of MRSA or resistant Gram-negatives (e.g. Pseudomonas), hospitalization and receipt of parenteral antibiotics in the last 90 days, or copious sputum production
  • Consider testing for Legionella urinary antigen in severe CAP (requiring ICU admission) or if patient is associated with a local Legionella outbreak