Coronavirus (COVID-19): do antibiotics aid in the treatment of COVID-19?

Cochrane Review: Popp M, Stegemann M, Riemer M, Metzendorf M-I, Romero CS, Mikolajewska A, Kranke P, Meybohm P, Skoetz N, Weibel S. Antibiotics for the treatment of COVID‐19. Cochrane Database of Systematic Reviews 2021, Issue 10. Art. No. CD015025. doi:10.1002/14651858.CD015025.¹

Background: On 11 March 2020 the World Health Organization (WHO) declared the novel coronavirus (COVID-19) outbreak a global pandemic.² As the world comes to terms with this new virus many existing treatments have been repurposed and trialled to determine efficacy against COVID-19 infection. Antibiotics have been considered as potential treatments. Macrolides are commonly used to treat both acute and chronic infections and their adverse effects are well established. They include azithromycin, clarithromycin, erythromycin, and roxithromycin. Tetracyclines and lincosamides are also being studied for their effects on COVID-19.¹ However, the WHO has identified that antimicrobial resistance (AMR) is a real threat to global health and so antibiotic use should be limited as much as possible.³ The Cochrane review reported on here set out to determine the effect of treating COVID-19 infection with antibiotics by analysing available randomised controlled trials.¹

Clinical Bottom Line: This Cochrane review found there are currently eleven completed studies that have tested azithromycin versus placebo or standard care in both inpatient and outpatient settings. Evidence shows that azithromycin does not decrease the risk of death in hospitalised patients and probably does not confer any benefits in either inpatient or outpatient populations. There are currently no studies comparing antibiotics to other efficacious interventions.¹