Antibiotic prescribing patterns for coronavirus disease 2019 (COVID-19) in two emergency departments with rapid procalcitonin

Initially, treatment guidelines for COVID-19 recommended empiric antibiotic usage, especially among those with severe disease.1 However, a systematic review indicated that, on average, 72% of COVID-19 patients received antibiotic therapy yet only 8% of patients had microbiologically confirmed coinfections.2 Currently, the World Health Organization (WHO) recommends antibiotics only for patients with moderate COVID-19 and a suspected bacterial infection.3 Although the available data indicate overuse of antibiotics in COVID-19 patients, available reports lack sufficient detail (eg, timing of administration and clinical scenario) to properly evaluate appropriateness. Patient Demographic and Clinical Encounter Characteristics Overall and by Antibiotic Group Characteristic Overall (n=73), No. (%) No Antibiotic (n=46), No. (%) Antibiotic (n=27), No. (%) P Valuea Age, y .067 0–19 6 (8) 5 (11) 1 (4) 20–49 21 (29) 16 (35) 5 (19) 50–59 13 (18) 8 (17) 5 (19) 60–69 10 (14) 4 (9) 6 (22) 70–79 10 (14) 3 (7) 7 (26) 80+ 13 (18) 10 (22) 3 (11) Sex, female 38 (52) 25 (54) 13 (48) .609 Hispanic or Latinx 13 (18) 9 (20) 4 (15) .756 Race .577 White 51 (70) 30 (65) 21 (78) Black 18 (25) 13 (28) 5 (19) Other 4 (6) 3 (7) 1 (4) Medical history Diabetes 22 (30) 13 (28) 9 (33) .648 Hypertension 38 (52) 25 (54) 13 (48) .609 Heart disease 10 (14) 9 (20) 1 (4) .080 COPD 4 (6) 3 (7) 1 (4) 1.00 Asthma 10 (14) 6 (13) 4 (15) 1.00 Other lung diseaseb 3 (4) 1 (2) 2 (7) .551 Symptoms Respiratory 61 (84) 39 (85) 22 (82) .751 Fever 51 (70) 32 (70) 19 (70) 1.00 GI 37 (51) 24 (52) 13 (48) .740 Date of COVID test .522 March 29 (40) 16 (35) 13 (48) April 26 (36) 18 (39) 8 (30) May 18 (25) 12 (26) 6 (22) Clinical score at ED visit/test .461 1–3 28 (38) 16 (35) 12 (44) 4+ 45 (62) 30 (65) 15 (56) Disposition .185 Discharged 26 (36) 19 (41) 7 (26) Admitted 47 (64) 27 (59) 20 (74) Mortality within 30 d 9 (12) 5 (11) 4 (15) .718 Intubation/mechanical ventilation 8 (11) 4 (9) 4 (15) .457 Procalcitonin .029 ≤0.25 35 (78) 22 (92) 13 (62) >0.25 10 (22) 2 (8) 8 (38) Note. COPD, chronic obstructive pulmonary disease; GI, gastrointestinal; ED, emergency department. a Comparison of group that had antibiotics prescribed and group that did not have antibiotics prescribed. b Other lung disease includes pulmonary fibrosis, cystic fibrosis, bronchiectasis, and pulmonary hypertension. Discussion Widespread use of antibiotics for COVID-19 has been reported worldwide, and the resulting risk of increased bacterial resista