COVID-19 (SARS Co-V2 infection)

Notes
  1. There is currently no antiviral therapy for COVID-19 infection, however some wards in NHS Ayrshire and Arran are taking part in the RECOVERY trial; which involves experimental treatment with agents such as hydroxychloroquine, azithromycin, lopinavir-ritonavir (Kaletra), low-dose dexamethasone (or IV hydrocortisone/PO prednisolone in pregnancy).
  2. Secondary bacterial super-infection is uncommon, but may be difficult to exclude.If there is no evidence of pneumonia and sputum is not purulent; Do not prescribe antibacterial therapy as it is unlikely to be a bacterial infection.
  3. CAP or HAP: Follow  Community-Acquired Pneumonia or  Hospital-Acquired Pneumonia
  4. Consider an ECG as soon as possible. If there is a suspicion of COVID-19 myocarditis avoid QT prolonging drugs, including macrolides (clarithromycin) and quinolones (levofloxacin) until ECG is known and is normal. If there are ECG changes/suspicion of myocarditis, doxycycline can be used for atypical cover if macrolides are contra-indicated. Contact Microbiology for an alternative to levofloxacin.
  5. Remember to consider important drug interactions with antibiotics-
  6. reduced absorption of doxycycline and oral levofloxacin when co-administered with cation-containing products (calcium or iron containing products/enteral feeds/antacids)
  7. Increased risk of myopathy when clarithromycin given with statins
  8. Reduction in seizure threshold with quinolones (levofloxacin)
  9. Adequate sampling for respiratory tract infections could allow avoidance of broad spectrum potentially toxic antibiotic treatment and quicker de-escalation to a more appropriate agent.
  10. Ensure a Legionella urinary antigen test is done in all patients with suspected pneumonia, as a negative result could remove the need for atypical antibacterial cover.
  11. Bibliography

1. Updated advice to Antimicrobial Teams (AMTs) on Antibiotic management/Antimicrobial Stewardship in the context of the COVID-19 pandemic. R A Seaton on behalf of Scottish Antimicrobial Prescribing Group 24/3/20 (Updated from 13/03/20)

2. Antibiotic prescribing in the context of COVID-19 pandemic - Implications for Adult Patients in Secondary Care. NHS GG&C. NHS GG&C AMT, Viii 26/3/20

3. Advice to Antimicrobial Teams (AMTs) on antibiotic prescribing in suspected lower respiratory tract infection in the context of the COVID-19 pandemic. R A Seaton on behalf of Scottish Antimicrobial Prescribing Group 12/05/20