Covid patients were given 'unecessary' amounts of antibiotics during the first wave of the pandemic despite bacterial infection being uncommon and contrary to UK guidelines.
Research led by the University of Glasgow found that found their use was high in hospitalised patients with a third prescribed drugs before they were even admitted.
Most of the bacteria identified were secondary infections beginning more than two days after patients were admitted to hospital. The bloodstream and chest infections were said to be similar to those that are hospital-acquired and "not specific to Covid-19".
Professor Calum Semple, who lead the study, warned that widespread over-use could pose a threat to the efficacy of antibiotics saying: “We only have safe surgery and medical cures for many life threatening conditions because antibiotics were discovered and mostly still work."
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UK guidelines advise against antibiotic use when the respiratory tract infection is thought to be due to Covid-19, without specific evidence of bacterial infection.
The study, which also involved the Universities of Edinburgh and Liverpool and Imperial College London, found that overall 85% of Covid-19 patients received one or more antibiotics during their hospital admission, with the highest use in critical care, while 37% of patients were prescribed antibiotics prior to admission.
There was high use of broad-spectrum antibiotics despite evidence that this could be reduced by using more targeted alternatives.
Importantly, confirmed bacterial infections in people with Covid-19 were uncommon, particularly when they were first admitted to hospital.
Most of the bacteria identified represented secondary infections which began more than 48 hours from admission.
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They were not specific to Covid-19 and were more in keeping with hospital-associated infections, particularly those typically seen in intensive care units.
Bacterial co-infections and secondary infections occur in up to a quarter of severe influenza and other severe respiratory viral infections, where they are also associated with increased morbidity and mortality.
The study aknowledged that there remains a need to monitor hospitalised patients in light of increased use of steroids and other Covid-19 treatments, which may increase susceptibility to bacterial infection.
However, the researchers argue that over-prescription of antibiotics and particularly broad-spectrum antibiotics in the majority of hospitalised patients with Covid-19 raises significant concern regarding the potential detrimental impact on antimicrobial resistance globally.
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Dr Antonia Ho, lead author of the study from the MRC-University of Glasgow Centre for Virus Research, said: "While some Covid-19 patients will require antibiotics, mostly for secondary infections which develop after admission to hospital, our data shows that not all patients should be prescribed antibiotics.
"The longer someone is in hospital, particularly if they are in critical care, the more vulnerable they are to develop secondary infections, and these should continue to be monitored.
"However, the bugs we identified are similar to those found in patients with hospital-acquired infection, and not specific to Covid-19.”
Prof Calum Semple added: “Overuse of antibiotics needs to be avoided to prevent emergence of resistance.
"When the current threat from COVID-19 subsides, the problem of antimicrobial resistance will remain a threat.”
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