AHS Recommendations for Antimicrobial Management of Adult Hospitalized Patients with COVID-19
Note: This is interim guidance prepared by Alberta Health Services (AHS) COVID-19 Antimicrobial Management Working Group. These recommendations will be frequently updated as new information becomes available.
The working group notes that there are no fully evidence-based effective therapies for the treatment of the novel coronavirus, SARS-CoV-2, and supportive care remains the mainstay of therapy for infected individuals. Prophylaxis and preemptive therapy are outside the scope of these recommendations.
Considerations for Potential COVID-19 Antiviral Agents
The use of experimental treatments for patients with COVID-19 should occur within the context of controlled clinical trials.
- Clinicians may be interested in pursuing any available therapy. A rapid review of antiviral therapies requested by the Public Health Agency of Canada (February 26, 2020) concluded “The current evidence for the effectiveness of antiviral therapies for coronavirus is not conclusive and suffers from a lack of well-designed prospective trials or observational studies. None of the interventions examined in this review can be recommended for use in patients with coronavirus”.
- The three antiviral agents that are currently felt to offer the best ratio of possible benefit to harm (and which are being assessed in the CATCO trial) are:
- lopinavir/ritonavir (Kaletra)
- hydroxychloroquine (Plaquenil)
Considerations for Antibiotic Therapy
- Antibiotics will have a limited role in managing COVID-19 patients, but recognizing the frequency with which antibiotics are used in patients with acute respiratory distress syndrome (ARDS), as well as the role of guidance and stewardship, the recommendations provided here are for:
- empiric management of patients with severe pneumonia while COVID-19 is being confirmed and bacterial infection excluded, and
- initial management of potential bacterial superinfection.
- Suggested investigations for suspect or confirmed COVID-19 patients under consideration for admission, or being admitted
- Other considerations for Patients Hospitalized due to COVID-19
- Empiric Antibiotic Therapy of Pneumonia