4 Assessing the ongoing need for antibiotics

4 Assessing the ongoing need for antibiotics

4.1 Review all antibiotics at 24 to 48 hours or as soon as test results are available.

When to stop antibiotics

4.2 Use the following signs, symptoms and test results to help inform the overall clinical assessment and decision about when to safely stop antibiotics:

  • no evidence of bacterial infection in blood, urine or sputum samples

  • a positive SARS‑CoV2 polymerase chain reaction (PCR) assay

  • fever resolved or resolving

  • symptoms and blood test results (particularly lymphopenia) consistent with COVID‑19 pneumonia

  • chest imaging (plain X‑ray, CT scan or lung ultrasound) consistent with COVID‑19 pneumonia (see recommendation 4.3).

4.3 Be aware that the 3 patterns on CT‑chest imaging consistent with COVID‑19 pneumonia according to stage of illness (from symptom onset) are:

Continuing antibiotics

4.4 Continue antibiotics if there is clinical or microbiological evidence of bacterial infection, regardless of SARS‑CoV2 PCR test results.

4.5 Think about continuing antibiotics if the SARS‑CoV2 PCR test is positive but clinical features are not typical for COVID‑19 pneumonia.

4.6 If antibiotics are continued:

  • review antibiotic choice based on microbiological test results and switch to a narrower spectrum antibiotic when appropriate.

  • give them for a total of 5 days, and then stop them unless there is a clear indication to continue (see recommendation 5.2)

  • review intravenous antibiotic use within 48 hours and think about switching to oral antibiotics (in line with prescribing table 1 and table 2).