Are antibiotics useful in COVID-19 pneumonia?
Since SARS-CoV-2 is a viral infection, it is not expected that antibiotics will be effective in COVID-19. However, if there are signs of bacterial superinfection antibiotics can and should be administered.
A recent study by a Gautret et al tested the effects of azithromycin in combination with hydrochloroquin and found that viral loads in patients treated with this combination therapy were significantly reduced (total n=23, treatment group n=26):
In critically ill patients with MERS, 18% had bacterial and 5% viral co-infections. Co-infection with Staphylococcus aureus is common with influenza pneumonia and can be especially virulent. Recent clinical practice guidelines recommend initiating empiric antibacterial therapy in adults with community-acquired pneumonia who test positive for influenza. Data from critically ill patients demonstrate secondary infection in about 11% of cases, although the numbers are small. Isolated organisms included gram-negative organisms such as K. pneumoniae, P. aeruganosa, and S. marcescens. On the basis of these limited data it is difficult to determine patterns of superinfection, including the risk of S. aureus infection, commonly seen in influenza.