Most patients with COVID-19 have mild respiratory disease and recover with supportive care alone. Investigational antivirals and immunomodulatory treatments may be considered as part of approved clinical trials and will be assessed by an Infectious Diseases physician prior to initiation in Nova Scotia Health (NSH).
Antibiotics for bacterial pneumonia are often unnecessary in patients with COVID-19. The rates of bacterial pneumonia co-infections and secondary infections are low.
Last revised November 2020
Empiric Bacterial Pneumonia Treatment in Patients With COVID-192
|COVID-19 Severity||Antibiotic Treatment|
|No antibiotic therapy|
No antibiotic therapy unless strong clinical suspicion for bacterial infection such as
A gradually worsening respiratory failure in the first week is more likely to be from progression of COVID-19 than from a new superimposed secondary bacterial pneumonia.
||Antibiotic treatment for community-acquired pneumonia (CAP), hospital-acquired pneumonia (HAP), or ventilator-associated pneumonia (VAP) as indicated (link to Spectrum)|
Other sources of infection (e.g. UTI, cellulitis, sepsis, etc) should be assessed as usual in COVID-19 patients and treated if indicated. There is no evidence that prolonged or more aggressive antimicrobial courses are warranted in COVID-19 patients.
Antibiotics are not benign and may result in adverse events including:
Last revised November 2020
1. Langford BJ, So M, Raybardhan S, Leung V, Westwood D, MacFadden DR, Soucy J-PR, Daneman N, Bacterial co-infection and secondary infection in patients with COVID-19:a living rapid review and meta-analysis Clinical Microbiology and Infection, https://doi.org/10.1016/j.cmi.2020.07.016
2. Ontario Clinical Practice Guidelines for Antimicrobial and Immunomodulatory Therapy. Available from: https://www.antimicrobialstewardship.com/covid-19
3. Clinical Management of COVID-19: interim guidance: World Health Organization; 2020 Available from: https://www.who.int/publications-detail/clinical-management-of-covid-19
4. Clinical Management of Patients with Moderate to Severe COVID-19 - Interim Guidance (April 2, 2020) Available from: https://www.ammi.ca/Content/Clinical%20Care%20COVID%2D19%20Guidance%20FINAL%20April2%20ENGLISH%281%29%2Epdf
5. Rawson TM, Moore LSP, Zhu N, Ranganathan N, Skolimowska K, Gilchrist M, et al. Bacterial and fungal co-infection in individuals with coronavirus: A rapid review to support COVID-19 antimicrobial prescribing. Clin Infect Dis. 2020.
6. Wang L, He W, Yu X, Hu D, Bao M, Liu H, et al. Coronavirus disease 2019 in elderly patients: Characteristics and prognostic factors based on 4-week follow-up. J Infect. 2020;80(6):639-45.
7. Wu CP, Adhi F, Highland K. Recognition and management of respiratory coinfection and secondary bacterial pneumonia in patients with COVID-19 [published online ahead of print, 2020 May 11]. Cleve Clin J Med. 2020;ccc015.
Last reviewed November 2020