Antibiotic therapy applied to COVID-19: The antimicrobials overuse consequences in the current treatment

Abstract

INTRODUCTION: Covid-19 prevention and control measures are linked to bacterial infections control. However, even with the greater care to sanitizing hands and ambience cleanliness, several authors have warned of a potential increase in multidrug-resistant bacteria due to the high use of antimicrobials in patients infected by Covid-19. AIM: To address the consequences of antibiotic misuse in treatment of Covid-19, as emphasizing the increase of multi-resistant bacteria. MATERIAL AND METHODS: As a systematic review, Latin American Literature in Science Health (LILACS) and Virtual Health Library (VHL) databases were consulted for open access articles released between 2015 and 2020. As search guide: "Bacteria", "Antibacterials", "Therapy" and "Covid-19" were used as descriptors. Among 17 articles found, 8 fulfilled the aim of this research. Fully available articles in Portuguese or English were used as inclusion criteria. RESULTS: The infected patient clinical conditions makes it difficult to diagnose a real bacterial coinfection, triggering the excessive use of antimicrobials even in the initial phase. The use of broad-spectrum antibiotics is common for critically ill patients undergoing mechanical ventilation. Non-randomized studies have indicated that antibiotics, mainly azithromycin, are a viable treatment for Covid-19. However, the early and misuse of broad-spectrum antimicrobials contributes to a multi-resistant bacteria development, characterizing a serious public health problem. These bacteria in a hospital environment, especially the ICU, increases the risk of healthcare-related infections (HAIs), which can aggravate the patient's clinical condition and lead to death. CONCLUSIONS: The high use of antibiotics during the current pandemic is related to a relatively effective treatment protocol for Covid-19, however, it can significantly increase levels of bacterial resistance. Therefore, the future possibility of infections with multidrug-resistant bacteria, without efficient antimicrobial treatment, is highlighted, characterizing a serious problem in the post-Covid-19 era.