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Pharmacologic Interventions

Last Updated: August 27, 2020

Antiviral Therapy  

See the Remdesivir section for a detailed discussion of these recommendations.

Immune-Based Therapy

Several immune-based therapies that are expected to modify the course of COVID-19 infection, 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., interleukin [IL]-1 or IL-6 inhibitors). Recommendations regarding immune-based therapy can be found in Immune-Based Therapy Under Evaluation for Treatment of COVID-19.

Corticosteroids

See the Corticosteroids section for a detailed discussion of these recommendations.

Empiric Broad-Spectrum Antimicrobial Therapy

Recommendations

  • 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 (BIII).
  • If antimicrobials are initiated, the COVID-19 Treatment Guidelines Panel recommends that their use should be reassessed daily in order to minimize the adverse consequences of unnecessary antimicrobial therapy (AIII).

Rationale

There are no reliable estimates of the incidence or prevalence of co-pathogens with COVID-19 at this time.

For patients with COVID-19, some experts routinely administer broad-spectrum antibiotics to all patients with 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 and cultures or testing of respiratory specimens are 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.

With influenza, empiric antibacterial treatment is strongly recommended for patients with initial severe disease (i.e., those with extensive pneumonia, respiratory failure, hypotension, and fever) and those who deteriorate after initial improvement.1 These recommendations are based on observations that bacterial superinfections, especially those due to Staphylococcus aureus and Streptococcus pneumonia, are not uncommon and have dire consequences if not treated promptly.

Whether moderate or severe COVID-19 disease should be approached like severe influenza will remain uncertain until more microbiologic and clinical data become available.

References

  1. Uyeki TM, Bernstein HH, Bradley JS, et al. Clinical practice guidelines by the Infectious Diseases Society of America: 2018 update on diagnosis, treatment, chemoprophylaxis, and institutional outbreak management of seasonal influenza. Clin Infect Dis. 2019;68(6):e1-e47. Available at: https://www.ncbi.nlm.nih.gov/pubmed/30566567.