Evaluation of Rational Use of Antibiotics in Patients with Covid-19: A Cross-sectional Retrospective Study

Abstract

Background: Coronaviruses, a family of closely related RNA viruses, encompass a spectrum of respiratory infections, ranging from mild to severe. While some cause milder illnesses such as the common cold, others, like severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), and coronavirus disease 2019 (COVID-19), can lead to more serious conditions, with COVID-19 being the cause of the current pandemic. Objectives: This cross-sectional retrospective study aimed to evaluate the rational use of antibiotics in patients with COVID-19 at Sina Hospital, affiliated with Tabriz University of Medical Science, and assess adherence to standard antibiotic prescribing guidelines provided by the Iranian Ministry of Health. Methods: During a period of about one year, 1,000 adult patients, aged 18 and above, with confirmed COVID-19 were randomly selected from the medical records of Sina Hospital. Inclusion criteria required a minimum hospital stay of 48 hours. Patients with shorter hospital stays were excluded. Data on demographic and clinical information — including comorbidities — and antibiotic use were collected using structured checklists. Antibiotic consumption was evaluated using the anatomical therapeutic chemical (ATC)/defined daily dose (DDD) methodology, and adherence to national guidelines was assessed. Results: The study included 1,000 adult patients. Of the 947 patients who received antibiotics, 492 (52%) were male and 455 (48%) were female. Diabetes mellitus (27.03%) and hypertension (29.56%) were the most prevalent comorbidities. Antibiotics were administered to 947 (94.7%) of the patients while they were in the hospital. Antibiotic use did not significantly differ between those who recovered (93.4%) and those who died (97.8%) (P = 0.157), indicating that the primary purpose of antibiotic use was to treat secondary infections rather than to affect the course of COVID-19. Vancomycin (32.2%), meropenem (24.7%), and ceftriaxone (46.2%) were the three most given antibiotics. About 95 ± 2% of antibiotic prescriptions followed the Iranian Ministry of Health’s recommendations. Conclusions: According to the study, the use of antibiotics by Sina Hospital’s COVID-19 patients was largely reasonable and in line with accepted practices for treating infections that are acquired in hospitals and the community. Antibiotic use and patient outcomes, however, did not significantly correlate. The single-center methodology and the exclusion of patients with brief hospital stays are two limitations that could restrict the findings’ applicability in other contexts with distinct patient demographics or healthcare systems. The study was limited by its retrospective single-center design and the exclusion of outpatients and those hospitalized for less than 48 hours, which may restrict generalizability to other settings or patient populations.