1st April 2020

COVID-19 pandemic challenges all aspect of healthcare including both recognition and management of serious acute bacterial infection and effective delivery of antimicrobial stewardship.

“The COVID-19 pandemic challenges all aspect of healthcare including both recognition and management of serious acute bacterial infection and effective delivery of antimicrobial stewardship. Serious bacterial infections may be missed when all attention focuses on COVID-19. It is therefore important to consider (investigate and empirically treat) bacterial infection when assessing the febrile patient and particularly those who have self isolated at home.  “Start smart then focus” principles apply in those who have commenced antibiotics: Review the diagnosis and management plan as more clinical information becomes available and ideally at 48-72 hours;  Ensure antibiotic duration is short as possible and as per local guidance and in those receiving IV antibiotics consider IV to oral switch daily. Ambulatory management in those with bacterial infection requiring ongoing IV or complex oral therapies should be maximised via referral to OPAT or “COPAT” (complex outpatient antibiotic therapy) services in order to minimise COVID-19 transmission risk to vulnerable patients.

 

There are no approved therapies for COVID-19 in the UK and experimental treatments (including Chloroquine/Hydroxychloroquine) are restricted to clinical trials (GOV.UK COVID-19). Although COVID-19 is a viral infection there are overlapping clinical and radiological features with bacterial respiratory tract infection so it is inevitable that antibiotics will be prescribed for many. Stewardship teams have a role in limiting antibiotic prescribing in suspected or proven COVID-19 infection. Consider antibiotics in those where bacterial infection cannot be excluded e.g. COPD exacerbations with purulent sputum or when radiological evidence of pneumonia. CRP is usually raised in COVID-19 and does not predict bacterial co-infection. Promote local infection management guidelines, remember IVOST when clinical improvement and limit duration to 5 days for the majority of respiratory indications. Remember drug interactions/toxicity: QTc prolongation (macrolides, quinolones), cation drug interactions (doxycycline, quinolones) and other drug interactions (macrolides, quinolones).”

 

– R. A. Seaton, Consultant in Infectious diseases NHS Greater Glasgow and Clyde, Chair of SAPG and Co-lead BSAC OPAT initiative @raseaton66

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