SHEA urged to limit unnecessary prescription of antibiotics during pandemics

SHEA urged to limit unnecessary prescription of antibiotics during pandemics
SHEA urged to limit unnecessary prescription of antibiotics during pandemics

The SHEA has called for limits on the inappropriate prescription of antibiotics during public health emergencies such as the coronavirus pandemic. The statement was published in the journal Infection Control & Hospital Epidemiology.

Experts noted that during the COVID-19 pandemic, the frequency of inappropriate prescription of antibiotics was extremely high. This has led to infections caused by multidrug-resistant organisms such as gram-negative extended-spectrum beta-lactamase-producing bacteria and methicillin-resistant Staphylococcus aureus. These infections complicate patient management, lengthen hospital stays, and worsen prognosis.

If a viral infection such as COVID-19 or influenza is highly likely, even if a definitive diagnosis is not established, the use of antibiotics, especially broad-spectrum drugs, should be limited to patients who are in intensive care units.

Markers of inflammation

At admission to the hospital, it is necessary to determine the level of inflammatory markers, especially in critically ill patients, including C-reactive protein, LDH, D-dimer, serum ferritin, and highly sensitive troponin. Laboratory studies should be repeated only if it is of practical importance.

Inflammatory markers are not always indicative of a bacterial or fungal infection and should not warrant antibiotics or antifungals. To resolve the issue of prescribing antibacterial drugs, one should not routinely prescribe a procalcitonin study.

Microflora research

In the absence of indicators consistent with a bacterial infection, microflora analysis or multiplex PCR should not be prescribed, especially if the patient is in a stable condition outside the intensive care unit. The appointment of multiplex PCR is indicated only for those in the intensive care unit and for those who require the appointment of broad-spectrum antibiotics. In addition, a routine examination for fungal infections should not be carried out in the absence of clinical manifestations.

Prescription of antibiotics

At the same time, the document noted that it is necessary to identify patients who require empirical antibiotics, although during the COVID-19 pandemic and other viral pandemics, co-infections were rare.

If the patient is in the hospital for more than 48-72 hours and the risk of nosocomial infections or multidrug resistance is high, antibiotics, including broad-spectrum drugs, may be prescribed if new symptoms appear that indicate the addition of an infection.

Before prescribing antibacterial drugs, the doctor should try to make a microbiological diagnosis. The microflora analysis should not be repeated if the patient’s clinical condition has not changed. The feasibility of using antibacterial drugs should be reviewed 48-72 hours after the start of therapy, taking into account the results of microbiological studies and clinical response to treatment.

Instrumental research methods

A chest x-ray is indicated to evaluate lung involvement. Daily repetition of the study is not shown. The use of CT is acceptable only if its results can affect the course of treatment.

The article is in Russian

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