COVID-19 rapid guideline: Managing co-infections
NICE guidelines:
Antibiotic treatment in the community
Recommendations
Do not offer an antibiotic for
preventing secondary bacterial pneumonia in people with COVID 19.
If a person has suspected or
confirmed secondary bacterial pneumonia, start antibiotic treatment as soon as
possible.
Advise people to seek medical help
without delay if their symptoms do not improve as expected, or worsen rapidly
or significantly, whether they are taking an antibiotic or not.
On reassessment, reconsider whether
the person has signs and symptoms of more severe illness and whether to refer
them to hospital or not.
Start antibiotic treatment as soon as
possible after establishing a diagnosis of community-acquired pneumonia, and
certainly within 4 hours (within 1 hour if the person has suspected sepsis and
meets any of the high risk criteria).
Give oral antibiotics first line if
the person can take oral medicines, and the severity of their condition does
not require intravenous antibiotics.
If intravenous antibiotics are given,
review by 48 hours and consider switching to oral antibiotics if possible.
Key Info for antibiotic
choices
For antibiotic choices to treat community-acquired pneumonia
caused by a secondary bacterial infection, see the recommendations on choice of
antibiotic in the below table.
Starting antibiotics in
hospital
Recommendations
Start empirical antibiotics if there is clinical suspicion of a secondary bacterial infection in people with COVID-19. When a decision to start antibiotics has been made:
start empirical antibiotic treatment as soon as possible after establishing a diagnosis of secondary bacterial pneumonia, and certainly within 4 hours
start treatment within 1 hour if the person has suspected
sepsis and meets any of the high-risk criteria
Doctors Liked to Read More
|
Table: Antibiotics for adults aged 18 years
and over |
|
|
Treatment |
Antibiotic, dosage and course length |
|
First-choice oral antibiotic if low severity |
Amoxicillin: 500 mg three times a day (higher doses can be used;
see the) for 5 days |
|
Alternative oral antibiotics if low severity, for
penicillin allergy or if amoxicillin unsuitable (for example, if atypical pathogens
suspected) |
Doxycycline: 200 mg on first day, then 100 mg once a day for
4 days (5‑day course in total) Clarithromycin: 500 mg twice a day for 5 days Erythromycin (in pregnancy): 500 mg four times a day for 5 days |
|
First-choice oral antibiotics if moderate severity (based on clinical judgment and
guided by microbiological results when available) |
Amoxicillin: 500 mg three times a day (higher doses can be used)
for 5 days With (if atypical pathogens suspected) Clarithromycin: 500 mg twice a day for 5 days Or Erythromycin (in pregnancy): 500 mg four times a day for 5 days |
|
Alternative oral antibiotics if moderate severity, for
penicillin allergy (guided
by microbiological results when available) |
Doxycycline: 200 mg on first day, then 100 mg once a day for
4 days (5‑day course in total) Clarithromycin: 500 mg twice a day for 5 days |
|
First-choice antibiotics if high severity (based on clinical judgement and by
microbiological results when available) |
Amoxicillin plus Clavulanate: 500/125 mg three times a day orally or 1.2 g
three times a day intravenously for 5 days With Clarithromycin: 500 mg twice a day orally or intravenously for
5 days Or Erythromycin (in pregnancy): 500 mg four times a day orally for 5 days |
|
Alternative antibiotic if high severity, for penicillin
allergy (guided by
microbiological results when available) |
Levofloxacin (consider safety issues): 500 mg twice a day orally or intravenously for
5 days |
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