Thread by @nickmmark

Meta-analysis of antibiotic prescribing in #COVID19 inpatients finds:
-74.6% received antibiotics 💊
-8.6% had bacterial co-infection 🧫

At first glance, this suggests that we’re *way* overprescribing Abx in COVID. But there are some caveats.
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clinicalmicrobiologyandinfection.com/article/S1198-…

First, Abx prescribing was much higher earlier in the pandemic (January 86% vs April 63%) and higher in China (76%) compared to the US (65%) & Europe (63%).

This suggests that overprescribing may be less of an issue currently and in the US.
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Second, only 5 studies (out of 154) reported the Abx duration. We don’t know if Abx was quickly de-escalated (appropriate) vs continued despite (-)cultures (inappropriate).

IMO It’s not wrong to start Abx in sick COVID pts so long as you promptly d/c when cultures are (-)

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Finally, we don’t know what triggered Abx use. Protocolized Abx is probably wrong. But using high PCT, high WBC count, or imaging findings to trigger Abx seems reasonable.

Conclusion: we probably do overuse Abx in COVID but it’s hard to identify the pts who really need em.
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