- A small study suggests that treatment of patients with moderate or severe COVID-19 with ceftazidime or cefepim plus the steroid dexamethasone is as effective as standard treatment.
- Antibiotic-plus-steroid treatment was associated with fewer side effects compared to standard treatment, which may involve seven or more different drugs.
- Laboratory tests and computer simulations showed that both antibiotics inhibit a key enzyme used by SARS-CoV-2, the virus that causes COVID-19.
- However, there is currently no evidence from clinical trials that antibiotics are effective against the virus, and experts warn that overconsumption promotes antibiotic resistance.
Healthcare professionals are always eager to emphasize that antibiotics are ineffective against viral infections, with some rare exceptions.
Antibiotics has saved the lives of millions of people since they came into widespread use in the early 20th century, but overconsumption is accelerating the development of bacterial resistance to the drugs.
Therefore, there are serious concerns over-regulation of antibiotics for patients with COVID-19 – in the absence of evidence of a bacterial co-infection – promotes the spread of antibiotic resistance.
In the United Kingdom is National Institute for Health and Care Excellence reports that less than 8% of those admitted with COVID-19 also have a bacterial infection.
During the pandemic, there had been early hope that the antibiotic azithromycin could be an effective treatment for COVID-19. However, one recently Cochrane review of clinical trials found no evidence of this.
So the results of a small study suggesting that one of two antibiotics, in combination with the steroid dexamethasone, may be an effective treatment for the disease are controversial.
The study involved 370 patients with moderate or severe COVID-19 who were admitted Beni-Suef University Hospital and Beni Suef, Egypt.
Researchers randomly assigned patients in three groups:
- treatment with cefepim plus dexamethasone: 124 patients
- treatment with ceftazidime plus dexamethasone: 136 patients
- standard COVID-19 treatment, as recommended in the World Health Organization (WHO) guidelines and the Egyptian management protocol, with seven or more drugs: 110 patients
The mean recovery time for patients treated with cefepim or ceftazidime was 12 days and 13 days, respectively, whereas the mean recovery time with standard treatment was 19 days.
The researchers emphasize that the study was not a clinical trial and that there were not a sufficient number of patients in each group to draw definite conclusions.
However, they also performed laboratory tests and computer simulations, which suggested that these two antibiotics inhibit the activity of a protease enzyme called
The study is published in the journal Antibiotics.
Cefepim and ceftazidime are broad-spectrum,
However, in their paper, the researchers argue that the use of existing antibiotics with proven antiviral potential against COVID-19 may actually delay the onset of antibiotic resistance.
Ahmed M. SayedPh.D., a pharmacist at Nahda University in Beni Suef and one of the authors, told Medical news today that the use of antibiotics that have both antiviral and antibacterial effects could avoid resistance to other antibiotics.
“Usually, upper respiratory tract viral infections are associated with secondary bacterial infections that require antibiotic coverage,” said Dr. Sayed.
“Therefore, if we use only a certain set of broad-spectrum antibiotics – which have additional antiviral potential as the two antibiotics studied in our article – in such types of infections, we will to some extent save other important antibiotics from the rapid development of bacterial resistance, and speed up the patient’s recovery rate, ”he explained.
He argued that using the full arsenal of antibiotics against bacterial coin infections would make these other drugs more ineffective.
In contrast, drugs such as cefepim and ceftazidime, which may have several therapeutic benefits, can reduce the number of other necessary treatments and their associated side effects.
The authors acknowledge that their study involved only a single hospital and was too small to draw definite conclusions.
“Of course, the study needs a much higher number of patients to get more solid results,” said Dr. Sayed.
He said they are planning a multisite clinical trial with these antibiotics, which will involve a larger number of patients and be more likely to yield statistically significant results.
In their paper, the researchers also note that their computer simulations and laboratory results can provide useful clues to design more potent antiviral drugs targeted at M.pro enzyme of SARS-CoV-2.
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