WHO updates COVID-19 guidelines: antibiotics advised only with suspected bacterial infection

World Health Organization (WHO), in its updated COVID-19 clinical care guidelines, has advised against the use of antibiotics when a bacterial co-infection is not suspected.

“This is a strong recommendation for patients with mild COVID-19, and a weaker or conditional one for patients with severe COVID-19,” it noted. The recommendations are based on new evidence as well as changes in the disease’s spread and severity.

“Recommendations about the use of antibiotics in COVID-19 patients are based on a recent systematic review and meta-analysis, and the pressing need to address antimicrobial resistance,” said WHO.

The updated guidelines are aimed at people directly or indirectly involved in the healthcare of patients with COVID-19 and post–COVID-19 conditions. This includes clinicians, allied healthcare workers, facility managers, and hospital administrators.

In its note, WHO said that there are two new recommendations about the use of antibiotics which follow from a recent meta-analysis of outcomes in patients treated with antibiotics for COVID-19.

“For patients with non-severe COVID-19 and a low clinical suspicion of a concurrent bacterial infection, we recommend no empirical antibiotics,” it said.

Empirical antibiotics are medications prescribed to treat infections before the specific cause (type of bacteria or other microorganism) is identified. This approach is used when the infection is severe or when waiting for lab results would cause significant harm to patients. Also, WHO added that for patients with severe COVID-19 and a low clinical suspicion of a concurrent bacterial infection, they suggest no empirical antibiotics.

WHO further added that these guidelines have evolved from the first version in 2020 in line with new information and changing circumstances of the pandemic.

“Notable changes to COVID-19 disease over this time have been overall reduced infection rates and reduced disease severity. Emergency measures which were imposed have also been removed, and care for patients with COVID-19 has become more integrated with usual healthcare systems. This different environment has prompted a review of the scope and content of all existing guidance. In order to maintain a clear focus and relevance, we have removed recommendations which would be considered general medical principles, and those which are no longer specific to the management of COVID-19,” it said.