Last Updated: October 9, 2020
See Therapeutic Management of Patients with COVID-19 for recommendations on the use of remdesivir with or without corticosteroids.
Several immune-based therapies that are expected to modify the course of COVID-19, including corticosteroids, are currently under investigation or are already in use. These agents may target the virus (e.g., convalescent plasma) or modulate the immune response (e.g., corticosteroids, interleukin [IL]-1 or IL-6 inhibitors). Recommendations regarding immune-based therapy can be found in Immune-Based Therapy Under Evaluation for the Treatment of COVID-19.
See Therapeutic Management of Patients with COVID-19 for recommendations on the use of dexamethasone with or without remdesivir.
Recommendations regarding adjunctive therapy used in the critical care setting, including antithrombotic therapy and vitamin C, can be found in the Adjunctive Therapy section.
Empiric Broad-Spectrum Antimicrobial Therapy
- In patients with COVID-19 and severe or critical illness, there are insufficient data to recommend empiric broad-spectrum antimicrobial therapy in the absence of another indication.
- If antimicrobials are initiated, the Panel recommends that their use should be reassessed daily in order to minimize the adverse consequences of unnecessary antimicrobial therapy (AIII).
There are no reliable estimates of the incidence or prevalence of copathogens with severe acute respiratory syndrome coronavirus 2 at this time.
Some experts routinely administer broad-spectrum antibiotics as empiric therapy for bacterial pneumonia to all patients with COVID-19 and moderate or severe hypoxemia. Other experts administer antibiotics only for specific situations, such as the presence of a lobar infiltrate on a chest X-ray, leukocytosis, an elevated serum lactate level, microbiologic data, or shock.
Gram stain, culture, or other testing of respiratory specimens is often not available due to concerns about aerosolization of the virus during diagnostic procedures or when processing specimens.
There are no clinical trials that have evaluated the use of empiric antimicrobial agents in patients with COVID-19 or other severe coronavirus infections.