key: cord-0776372-bkdszmbv
authors: Pinxt, C M H; Bogie, R M M; Hanssen, N M J; Spaetgens, B
title: COVID-19: a wake-up call for antibiotic overuse in older patients?
date: 2021-09-06
journal: QJM
DOI: 10.1093/qjmed/hcab234
sha: 460480336bcea6fc97135c217a281b6315fc86f5
doc_id: 776372
cord_uid: bkdszmbv

nan

We greatly appreciate the interest in our clinical picture 'Antibiotic overuse in older patients: An important clinical reminder of pseudomembranous colitis' by Dr Jolobe. 1, 2 We hereby take the opportunity to further elaborate on the overuse of antibiotics in older individuals.

The cases presented by Dr Jolobe precisely pinpoint the key issues at hand in antibiotic overuse, and that these issues, if anything, have been exacerbated by the COVID-19 pandemic. First, when in a clinical dilemma, practitioners tend to err on the side of antibiotic prescription, especially when appropriate guidelines are lacking, such as in the beginning of the COVID-19 pandemic. Nevertheless, even though we welcome specific guidelines to reinforce good antimicrobial stewardship in the meantime, emerging studies still reveal suboptimal antibiotic use. 3, 4 Indeed, as highlighted by Dr Jolobe, estimates on the prevalence of bacterial super-infections vary widely, and to our knowledge, no trial has convincingly shown that systematic antibiotic use reduces poor outcomes in the various stages of COVID19. Secondly, it is worth noting that the patients used to illustrate how readily the lurking threat of antibiotic overuse is present, were only 51-and 60-year-old. Bearing in mind the atypical presentation of illness, presence of frailty and comorbid conditions among older individuals, it is likely the balance will tip to antibiotic prescription even more often in this frail population. This is an important issue, since older individuals are at an increased risk of complications by antibiotic use. Notwithstanding, it goes without saying that antibiotics have made an indispensable impact on global health, but to fully maximize their benefit the presumed benefits of antibiotic prescription must be weighed against their increased risks, at both individual and population levels. In the meanwhile, we wholeheartedly support the call made by Dr Jolobe and other colleagues not to neglect antibiotic stewardship during the COVID-19 pandemic.

Conflict of interest. None declared.

Antibiotic overuse in older patients: an important clinical reminder of pseudomembranous colitis

A more appropriate use of antibiotics in COVD-19 infection

The COVID-19 pandemic: a threat to antimicrobial resistance containment

Antimicrobial resistance threats in the emerging COVID-19 pandemic: where do we stand?

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