RESUMEN
In a single-center review of antibiotic prescribing in COVID-19 patients, 10% of patients received antimicrobials, and inpatients encounters had the highest rate and spectrum of prescribing. Prescribing rate, spectrum, and duration appeared to increase with disease severity in inpatients. Antimicrobial prescribing in patients managed in ambulatory encounters was less common.
Asunto(s)
Antiinfecciosos/uso terapéutico , Programas de Optimización del Uso de los Antimicrobianos , Infecciones Bacterianas , COVID-19 , Coinfección , Pautas de la Práctica en Medicina , Programas de Optimización del Uso de los Antimicrobianos/métodos , Programas de Optimización del Uso de los Antimicrobianos/normas , Infecciones Bacterianas/epidemiología , Infecciones Bacterianas/terapia , COVID-19/epidemiología , COVID-19/terapia , Coinfección/tratamiento farmacológico , Coinfección/epidemiología , Continuidad de la Atención al Paciente/estadística & datos numéricos , Utilización de Medicamentos/estadística & datos numéricos , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Minnesota/epidemiología , Servicio Ambulatorio en Hospital/estadística & datos numéricos , Pautas de la Práctica en Medicina/normas , Pautas de la Práctica en Medicina/estadística & datos numéricos , SARS-CoV-2/aislamiento & purificación , Centros de Atención Terciaria/estadística & datos numéricosAsunto(s)
Programas de Optimización del Uso de los Antimicrobianos , Infecciones por Coronavirus , Emblemas e Insignias , Pandemias , Neumonía Viral , Antibacterianos , Azitromicina , Betacoronavirus , COVID-19 , Infecciones por Coronavirus/tratamiento farmacológico , Humanos , Hidroxicloroquina , Estudios Prospectivos , SARS-CoV-2 , Tratamiento Farmacológico de COVID-19RESUMEN
OBJECTIVES: Despite low rates of bacterial coinfection in patients admitted with COVID-19, antimicrobials are frequently prescribed. Our primary objective was to evaluate antimicrobial prescribing over time in patients admitted with COVID-19. The secondary objectives were to evaluate the role of ID providers in antimicrobial utilization, describe the rate of confirmed bacterial infection and determine factors associated with empirical antimicrobial prescribing in COVID-19. MATERIALS AND METHODS: Retrospective review was performed for adult patients admitted to a tertiary care centre with COVID-19 between 1 March 2020 and 30 November 2020. Patient demographics, disease severity, risk factors for severe disease, clinical outcomes, antimicrobial prescribing and respiratory microbiological testing were collected and analysed. Prescribing trends were evaluated by month, and factors contributing to prescribing were established using univariate and multivariable analysis. RESULTS: Antibiotics were prescribed during admission in 37.9% of the study cohort, with 85.1% of patients who received antibiotics having therapy initiated within 48 h of admission. Antibiotic prescribing incidence increased with disease. Over the study period, antimicrobial prescribing rates decreased by 8.7% per month. Multivariable analysis found ICU admission, obtainment of procalcitonin values, intubation, heart failure, haemodialysis and nursing home residence were associated with empirical antimicrobial prescribing. CONCLUSIONS: Unnecessary antimicrobial prescribing in patients with viral syndromes like COVID-19 continues to represent an area of concern. Antimicrobial stewardship efforts during COVID-19 should consider patient-specific factors associated with antibiotic prescribing. Recognition of such factors, in combination with application of well-established antimicrobial stewardship tactics, may serve to impact antimicrobial prescribing trends, even as patient volumes rise.
Asunto(s)
Programas de Optimización del Uso de los Antimicrobianos/métodos , Tratamiento Farmacológico de COVID-19 , Servicio de Farmacia en Hospital/métodos , Comité Farmacéutico y Terapéutico , Programas de Optimización del Uso de los Antimicrobianos/organización & administración , Humanos , Preparaciones Farmacéuticas/provisión & distribución , Servicio de Farmacia en Hospital/organización & administración , Comité Farmacéutico y Terapéutico/organización & administraciónAsunto(s)
Betacoronavirus , Intercambio de Información en Salud , Estado de Salud , Pandemias/prevención & control , Servicios Preventivos de Salud/organización & administración , COVID-19 , Infecciones por Coronavirus/epidemiología , Humanos , Pandemias/estadística & datos numéricos , Neumonía Viral/epidemiología , SARS-CoV-2RESUMEN
In many different infectious syndromes, most notably several viral conditions, time to therapy initiation from symptom onset has been identified as a critical component contributing to the success of therapy. Regarding COVID-19, several therapeutic antivirals, both repurposed and novel, have been evaluated for overall safety and efficacy. As the literature related to these therapies has expanded recently, a wide array of trial designs, time to therapy initiation thresholds, and clinical outcomes in regard to time to initiation have been reported. We describe the potential effects of time to therapy initiation on outcomes in patients with COVID-19 and detail the existing data surrounding this topic in relation to remdesivir, convalescent plasma, lopinavir/ritonavir, and hydroxychloroquine.
RESUMEN
In an effort to "flatten the curve" of SARS-CoV-2, society is urged to practice social distancing. However, the management of other disease states may require some patients to undergo outpatient parenteral antimicrobial therapy (OPAT). Practical considerations for OPAT management during an infectious pandemic are reviewed. These include shortening durations of therapy, utilizing the oral route, avoiding medications requiring therapeutic drug monitoring, selecting antimicrobials with long durations, decreasing frequency of laboratory blood draws, and performing tele-health visits.
RESUMEN
The novel severe acute respiratory syndrome coronavirus 2 is causing a worldwide pandemic that may lead to a highly morbid and potentially fatal coronavirus disease 2019 (COVID-19). There is currently no drug that has been proven as an effective therapy for COVID-19. Several candidate drugs are being considered and evaluated for treatment. This includes clinically available drugs, such as chloroquine, hydroxychloroquine, and lopinavir/ritonavir, which are being repurposed for the treatment of COVID-19. Novel experimental therapies, such as remdesivir and favipiravir, are also actively being investigated for antiviral efficacy. Clinically available and investigational immunomodulators, such as the interleukin 6 inhibitors tocilizumab and sarilumab and the anti-granulocyte-macrophage colony-stimulating factor lenzilumab, are being tested for their anticipated effect in counteracting the pro-inflammatory cytokine environment that characterizes severe and critical COVID-19. This review article examines the evidence behind the potential use of these leading drug candidates for the treatment of COVID-19. The authors conclude, based on this review, that there is still no high-quality evidence to support any of these proposed drug therapies. The authors, therefore, encourage the enrollment of eligible patients to multiple ongoing clinical trials that assess the efficacy and safety of these candidate therapies. Until the results of controlled trials are available, none of the suggested therapeutics is clinically proven as an effective therapy for COVID-19.