Do antibiotics work to combat coronavirus?

coronavirus antibiotics
Photo via The Javorac/Flickr (CC BY 2.0)

There are generally two types of germs that can cause an infection: viruses and bacteria. Antibiotics are defined as powerful medicines used to treat illnesses caused by bacteria, like strep throat and infections in the ear, the sinus, and the urinary tract. COVID-19, also referred to as coronavirus, is caused by a virus and can therefore not be alleviated or cured by antibiotics.

Though antibiotics are considered effective in combating certain illnesses—including life-threatening conditions such as pneumonia or sepsis—and protecting people who are undergoing surgery, receiving chemotherapy, or are considered high risk for developing infections, using them can cause side effects and often lead to antibiotic resistance. According to the CDC, antibiotic resistance is one of the most urgent threats to the public’s health. It occurs when bacteria become impervious to the drugs that are prescribed to get rid of them. When this happens, the bacteria will continue to cause infection in the body, rendering the drug useless.

One of the main causes of antibiotic resistance is the unnecessary prescription of antibiotics. About 30% of antibiotics (the equivalent of 47 million prescriptions) are doled out by doctors’ offices and emergency departments in the United States. A new study entitled “Bacterial and fungal co-infections in COVID-19 patients hospitalized during the New York City pandemic surge” analyzed COVID-19 patients admitted between March and May at one of the busiest hospitals in New York City during the pandemic surge. Researchers found that over 70% were given antibiotics. Further analysis of the patients included in the study revealed that bacterial and fungal co-infections only occurred in less than 5%, most of whom were the most vulnerable of cases.

Dr. Priya Nori, the lead researcher of the study and a specialist in infectious diseases at Montefiore Medical Center in New York, explained that a bad case of COVID-19 mimics all the signs for bacterial pneumonia. Back when little was known about coronavirus, it wasn’t apparent whether the virus by itself caused severe symptoms. Earlier this year, research conducted suggested antibiotics were a necessary part of COVID-19 treatment, because a large number of patients reportedly died of secondary infections rather than the coronavirus itself. One of the antibiotics that emerged from these series of early studies was azithromycin, a drug—commonly used for bacterial respiratory infections—that when used in combination with the anti-malaria drug hydroxychloroquine, was lauded as an effective cocktail against COVID-19.

Since its emergence as a potential solution, however, many more studies have come out concluding that there actually is no benefit or advantage to adding azithromycin to standard of care treatments for the disease because it “did not result in clinical improvement or mortality reduction,” as one of the studies published in The Lancet Journal reported. The FDA also revoked the emergency use authorization for hydroxychloroquine as it has been found “unlikely to be effective in treating COVID-19.”

While antibiotics are not designed to treat viral infections like coronavirus, it is important to note that co-infection with multiple ailments is highly probable in most coronavirus patients. Those hospitalized for the disease can still contract bacterial, fungal, or viral infections at the same time.

In its latest tips for healthcare workers updated this month, the CDC reported that several coronavirus patients also developed community-acquired bacterial pneumonia simultaneously. “Decisions to administer antibiotics to COVID-19 patients should be based on the likelihood of bacterial infection (community-associated or healthcare-associated), illness severity, and current clinical practice guidelines,” the memo reads. 

Sources: John Hopkins Medicine, WHO, CDC, Cambridge, Medical Xpress, Science, The Lancet Journal, FDA

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