- COVID-19 is a viral infection.
- Antivirals or agents with antiviral properties for COVID-19 should not be prescribed for treatment or prophylaxis in the community, unless as part of a clinical trial.
- Secondary bacterial infection appears uncommon in COVID-19 patients.
- Differentiating viral (COVID-19) versus bacterial pneumonia
- Viral more likely if;
- history of typical COVID-19 symptoms for about a week
- severe muscle pain (myalgia),
- loss of sense of smell (anosmia), taste (dysgeusia)
- breathless but has no pleuritic pain
- history of exposure to known or suspected COVID-19, such as a household or workplace contact.
- Bacterial more likely if;
- became rapidly unwell after only a few days of symptoms
- does not have a history of typical COVID-19 symptoms
- purulent sputum
- underlying chronic lung disease with history of secondary bacterial infection in winters e.g. in acute infective exacerbation of COPD.
- If antibiotics are prescribed remember:
- Keep duration as short as possible
- May cause side effects
- Broad-spectrum antibiotics in particular may lead to Clostridioides difficile infection
- Consider drug interactions
- Consider renal impairment dose adjustment
- Frail elderly patients are at greater risk of complication and death from all infections. Although there may be a lower threshold for prescribing antibiotics, older patients are also at greater risk of harm from antibiotics.
* Alternative doxycycline dose: 100mg every 12 hours.
In non-severe infection, 200mg stat then 100mg every 24 hours can be considered.
Reviewed November 2020