March 20, 2024

expert reaction to cohort study of early antibiotic use in COVID-19 patients and short and long-term outcomes

A study published in the Journal of Medical Virology looks at antibiotic use in COVID-19 patients. 

Prof Christopher Butler, Professor of Primary Care, University of Oxford, said:

“This study did not randomise participants. Despite this, the authors claim that early initiation of antibiotic therapy resulted in a significantly shorter recovery time from COVID-19. They say early initiation of antibiotics played a crucial role in maintaining higher levels of blood oxygen saturation. The study design does not allow conclusions for effectiveness, merely of associations. There are many potential baseline differences between those in the different treatment groups which cannot be accounted for by their analysis. The authors fail to mention prospective randomized control trials of antibiotic use for COVID-19 in the community that showed no benefit.^1,2  The suggestion that antibiotic treatment will improve short- and long-term outcomes in SARS-CoV-2 is not supported by these data. Using antibiotics at scale for COVID-19, especially given results from more rigorous study designs, is likely to merely put patients at unnecessary risk of adverse events,  waste resources, and drive antimicrobial resistance.”

1. Principle Trial Collaborative Group. Azithromycin for community treatment of suspected COVID-19 in people at increased risk of an adverse clinical course in the UK (PRINCIPLE): a randomised, controlled, open-label, adaptive platform trial. Lancet 2021;397(10279):1063-1074. DOI: 10.1016/S0140-6736(21)00461-X.
2. Butler CC, Yu LM, Dorward J, et al. Doxycycline for community treatment of suspected COVID-19 in people at high risk of adverse outcomes in the UK (PRINCIPLE): a randomised, controlled, open-label, adaptive platform trial. Lancet Respir Med 2021;9(9):1010-1020. DOI: 10.1016/S2213-2600(21)00310-6.

‘A retrospective cohort study on early antibiotic use in vaccinated and unvaccinated COVID‐19 patients’ by Carlo Brogna et al. was published in Journal of Medical Virology at 7:01 UK time on Wednesday 20^th March, which is also when the embargo will lift.

DOI: 10.1002/jmv.29507

Declared interests

Prof Christopher Butler: I am the Chief Investigator of the PRINCIPLE and PANORAMIC trials.