Evidence map›Paper›PMID 33418017›Full record

SynthesisClinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases2021

Antibiotic prescribing in patients with COVID-19: rapid review and meta-analysis.

Bradley J Langford, Miranda So, Sumit Raybardhan, Valerie Leung, Jean-Paul R Soucy, Duncan Westwood, Nick Daneman, Derek R MacFadden

Open access · bronzeAbstract readMeta-AnalysisReview
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 478 papers, 6 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
478citing papers in PubMed, 6 pooled it
94.0field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

478 citing papers in PubMed, 6 syntheses or guidelines pooled it, 866 citations in OpenAlex.

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  14. Influence of COVID-19 on Clinical Outcomes ofAntibiotics (Basel, Switzerland) · 2026
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  16. Journal of clinical medicine · 2026
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418 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 7 institutions in 1 country.

Bradley J LangfordPublic Health Ontario, ON, Canada; Hotel Dieu Shaver Health and Rehabilitation Centre, ON, Canada. Electronic address: brad.langford@gmail.com.
Miranda SoSinai Health-University Health Network Antimicrobial Stewardship Program, University Health Network, Toronto, Canada; University of Toronto, ON, Canada; Toronto General Hospital Research Institute, Toronto, ON, Canada.
Sumit RaybardhanNorth York General Hospital, ON, Canada.
Valerie LeungPublic Health Ontario, ON, Canada; Toronto East Health Network, Michael Garron Hospital, ON, Canada.
Jean-Paul R SoucyDivision of Epidemiology, Dalla Lana School of Public Health, University of Toronto, ON, Canada.
Duncan WestwoodSunnybrook Research Institute, ON, Canada.
Nick DanemanPublic Health Ontario, ON, Canada; University of Toronto, ON, Canada; Sunnybrook Research Institute, ON, Canada; ICES (formerly Institute for Clinical Evaluative Sciences), ON, Canada.
Derek R MacFaddenOttawa Hospital Research Institute, ON, Canada.
Public Health Ontario · CAInstitute for Clinical Evaluative Sciences · CANorth York General Hospital · CAOttawa Hospital Research InstituteSunnybrook Hospital · CAToronto East General Hospital · CAUniversity of Toronto · CA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe proportion of patients infected with SARS-CoV-2 that are prescribed antibiotics is uncertain, and may contribute to patient harm and global antibiotic resistance.

objectiveThe aim was to estimate the prevalence and associated factors of antibiotic prescribing in patients with COVID-19. DATA SOURCES: We searched MEDLINE, OVID Epub and EMBASE for published literature on human subjects in English up to June 9 2020. STUDY ELIGIBILITY CRITERIA: We included randomized controlled trials; cohort studies; case series with ≥10 patients; and experimental or observational design that evaluated antibiotic prescribing.

participantsThe study participants were patients with laboratory-confirmed SARS-CoV-2 infection, across all healthcare settings (hospital and community) and age groups (paediatric and adult).

methodsThe main outcome of interest was proportion of COVID-19 patients prescribed an antibiotic, stratified by geographical region, severity of illness and age. We pooled proportion data using random effects meta-analysis.

resultsWe screened 7469 studies, from which 154 were included in the final analysis. Antibiotic data were available from 30 623 patients. The prevalence of antibiotic prescribing was 74.6% (95% CI 68.3-80.0%). On univariable meta-regression, antibiotic prescribing was lower in children (prescribing prevalence odds ratio (OR) 0.10, 95% CI 0.03-0.33) compared with adults. Antibiotic prescribing was higher with increasing patient age (OR 1.45 per 10 year increase, 95% CI 1.18-1.77) and higher with increasing proportion of patients requiring mechanical ventilation (OR 1.33 per 10% increase, 95% CI 1.15-1.54). Estimated bacterial co-infection was 8.6% (95% CI 4.7-15.2%) from 31 studies.

conclusionsThree-quarters of patients with COVID-19 receive antibiotics, prescribing is significantly higher than the estimated prevalence of bacterial co-infection. Unnecessary antibiotic use is likely to be high in patients with COVID-19.

Indexed as

COVID-19Drug PrescriptionsDrug UtilizationAge FactorsAnti-Bacterial AgentsAntimicrobial StewardshipBacterial InfectionsCoinfectionFemaleHumansMaleAnti-Bacterial AgentsAntibiotic PrescribingAntibioticsAntimicrobial StewardshipAntimicrobial therapyCOVID-19SARS-CoV-2

Identifiers

PMID33418017
PMCPMC7785281
OpenAlexW3118291996

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.