The differential diagnosis of patients presenting to hospital unwell from the community with suspected COVID-19 and the antibiotic management in this patient population should follow a structured approach. To help guide decision making in patients with suspected COVID-19, a guideline (linked below) has been put together which follows three main steps:
Step 1: Assessment
Determine the likelihood of COVID-19, COVID-19 with superadded (aka secondary) bacterial infection, or community acquired pneumonia (CAP) using chest x-ray and blood tests. If the patient has pneumonia on the chest x-ray and increased neutrophils and increased procalcitonin (>0.25mg/l) it is likely they have CAP or COVID-19 with superadded bacterial infection, and these patients should proceed down the pathway to Step 2 for management with antibiotics.
Step 2: Manage
Patients should be risk stratified using the CURB-65 score and whether they have sepsis, and treated with antibiotics accordingly. The guideline, found below, provides suggested antibiotics and dosages (please check your local guidelines as they may differ slightly).
Step 3: COVID-19 test results
The ongoing antibiotic management depends on the result of the COVID-19 result. If the throat swab is negative, alternative non-COVID diagnoses should be considered, including atypical pneumonia (especially Mycoplasma and Legionella), other respiratory viruses and HIV.