Antibacterial Therapy of Patients With COVID-19 During The Outpatient and Hospital Stages

Although antibiotics (AB) are ineffective for the treatment of COVID-19, they are often prescribed to patients with the novel coronavirus infection (NCV) for a variety of reasons. They include the difficulty of excluding bacterial co-infection at the first contact with the patient, as well as the possibility of developing a secondary bacterial infection. The aim  of the work is to assess the frequency and background of prescribing antibiotics to hospitalized patients with confirmed COVID-19. Material and methods. A retrospective analysis of 160 hospital records of patients with confirmed COVID-19, who were treated in various Infectious Diseases Departments during the period from September to October 2020, was carried out. The selection was done by the method of random sampling. The analysis did not include the records of patients admitted to the ICU for NCV. Results. Information about the appointment of antibacterial drugs before hospitalization was found in 109 patients, of which only 51 patients did not receive AB on an outpatient basis. The remaining 58 (53.2%) patients began taking ABs on their own or based on the recommendation of an outpatient doctor, including 31 patients who took two or more drugs (successively or simultaneously). The most commonly used antibiotics were: macrolides (37 patients), cephalosporins (24 patients), respiratory fluoroquinolones (12 patients), and aminopenicillins (5 patients). On admission, AB was prescribed for almost all patients, except for one. The most frequently prescribed antibiotics were: macrolides (61%), mainly azithromycin, and respiratory fluoroquinolones (54.1%), mainly levofloxacin. In most cases, these drugs were combined with 3rd or 4th generation cephalosporins. Most patients received more than one AB: two drugs were prescribed to 86 (54.1%) patients, three — to 34 (21.4%) patients. AB therapy was carried out for a long time: the maximum number of days for macrolide administration (excluding previous AB therapy at the outpatient stage) was 16 days, respiratory fluoroquinolones — 22 days,3rd generation cephalosporins — 19 days,4th generation cephalosporins — 17 days, carbapenems — 34 days. In almost 100% of cases, ABs were prescribed on the first day of admission of patients, and their therapy continued until the patient was discharged from the hospital. Conclusion. The appointment of antibiotics at the hospital stage was established for the vast majority of patients in the absence of clear indications for their appointment. Such a frequent prescription of antibiotics is accompanied by a number of problems: immediate – side effects of such therapy (for example, antibiotic-associated diarrhea), long-term — an increase in antibiotic resistance of microorganisms.