COVID-19 (SARS Co-V2 infection)
- 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).
- 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.
- CAP or HAP: Follow Community-Acquired Pneumonia or Hospital-Acquired Pneumonia
- 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.
- Remember to consider important drug interactions with antibiotics-
- reduced absorption of doxycycline and oral levofloxacin when co-administered with cation-containing products (calcium or iron containing products/enteral feeds/antacids)
- Increased risk of myopathy when clarithromycin given with statins
- Reduction in seizure threshold with quinolones (levofloxacin)
- 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.
- 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.
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