At the start of the COVID-19 pandemic, severely ill patients were often prescribed pandemic antibiotics even though the disease is caused by a virus. Win McNamee / Getty Images Hide caption
Win McNamee / Getty Images
Win McNamee / Getty Images
Doctors treating COVID-19 patients at the start of the pandemic often resorted to antibiotics. But these drugs have not been helpful in most cases, and overuse of antibiotics is a serious problem.
Several research groups, at Johns Hopkins, the University of Michigan and Bristol, Englandhave observed this trend. Now researchers from the Pew Charitable Trusts have weighed with more data and place these findings in the context of long-term concerns about the fate of antibiotics.
The Centers for Disease Control and Prevention estimates that nearly 3 million Americans get an infection every year caused by a drug-resistant microbe. An estimated 35,000 Americans die each year from these difficult-to-treat infections.
As a result, hospitals should follow rules to limit the unnecessary use of antibiotics. Excessive use of these drugs will accelerate the development of new drug-resistant strains of bacteria.
However, these rules were not strictly followed during the COVID-19 pandemic, especially in the early days.
Here is the scene that doctors face. “You have a patient with this potentially fatal disease,” he says Dr. Susan Swindells, an infectious disease specialist at the University of Nebraska Medical Center. “They have a fever and a cough, and they have difficulty breathing. So the overwhelming desire is to do all you can.”
In the absence of effective drug therapy, this often meant reaching for antibiotics. Some patients were treated only in case they actually had bacterial pneumonia, not COVID-19. In other cases, doctors suspected that patients could have both COVID-19 and a bacterial infection. This double infection is quite common in people with influenza in the hospital.
At the time, she says, “there was very little proven treatment for COVID, so people tried all sorts of things.”
“I think we are all aware of COVID overuse,” she said. And it’s hardly unique. “Many people with the flu or even colds get prescribed antibiotics when they don’t need them. This is definitely a problem.”
Rachel Zetts of the Pew Charitable Trusts documents the use of antibiotics for COVID-19. The study of a group of around 5,000 hospitalized patients, mostly in the Midwest, found that more than half were receiving antibiotics, although most of them did not have bacterial infections.
Patients usually received the antibiotics right away before doctors had time to run tests to rule out bacterial infections.
Doing this is “inherently not a bad practice,” says Zett’s co-author, Dr. David Hyun from Pew. “It is a necessary tool for providers to treat patients with suspected bacterial infections by the time they reach hospital doors.”
For example, prompt treatment can save the life of a person with sepsis. This is caused by a bacterial infection.
However, as the pandemic developed, it became increasingly clear that antibiotics were not helping most COVID-19 patients.
Doctors usually stopped therapy within a few days once they determined that their patients were not getting any benefit from it. Even so, this practice contributes to the overuse of antibiotics and can gradually undermine their effectiveness. Hyun says hospitals have been forced to issue guidelines in recent years to curb the inappropriate use of antibiotics.
“We are concerned that the progress we’ve seen over the past few years may be reversed.”
The studies so far mainly relate to media practices that were used in the first six months of the pandemic. Since then, doctors have had effective drugs available and have learned that their patients rarely get secondary bacterial infections.
Swindells says in her hospital that this has reduced the impulse to reach for antibiotics.
“It goes on to a certain extent, but it has improved,” she says.
These lessons have likely been learned in most of the places where COVID-19 is treated. Pew researchers are excited to see the results of follow-up studies to see if this is actually the case.
You can contact NPR science correspondent Richard Harris at [email protected].