Background: The aim of this review was to evaluate the efficacy and safety of antibiotic agents in children with COVID-19, as well as to introduce the present situation of antibiotics use and bacterial coinfections in COVID-19 patients. 

Methods: We searched Cochrane library, Medline, Embase, Web of Science, CBM, Wanfang Data and CNKI from their inception to March 31, 2020. In addition, we searched related studies on COVID-19 published before March 31, 2020 through Google Scholar. We evaluated the risk of bias of included studies, and synthesized the results using a qualitative synthesis. 

Results: Six studies met our inclusion criteria. Five studies on SARS showed an overall risk of death of 7.2% to 20.0%. One study of SARS patients who used macrolides, quinolones or beta lactamases showed that the mean duration of hospital stay was 14.2, 13.8 and 16.2 days, respectively, and their average duration of fever was 14.3, 14.0 and 16.2 days, respectively. One cohort study on MERS indicated that macrolide therapy was not associated with a significant reduction in 90-day mortality (adjusted odds ratio [OR] 0.84, 95% confidence interval [CI] 0.47-1.51, P = 0.56) and improvement in MERS-CoV RNA clearance (adjusted hazard ratio [HR] 0.88, 95% CI 0.47, -1.64], P = 0.68). According to the findings of 33 studies, the proportion of antibiotics use ranged from 19.4% to 100.0% in children and 13.2% to 100.0% in adults, despite the lack of etiological evidence. The most commonly used antibiotics in adults were quinolones, cephalosporins and macrolides and in children meropenem and linezolid.

Conclusions: The benefits of antibiotic agents for adults with SARS or MERS were questionable in the absence of bacterial coinfections. There is no evidence to support the use of antibiotic agents for children with COVID-19 in the absence of bacterial coinfection.

https://medrxiv.org/content/10.1101/2020.04.13.20064402v1.full.pdf

Efficacy and Safety of Antibiotic Agents in Children with COVID-19: A Rapid Review

ObjectiveTo analyse the causes and to evaluate treating strategies of the patients occurring at the anaphase of the critical severe acute respiratory syndrome (SARS) by summarizing their complications.MethodsTo analyse retrospectively the underlying condition,complications,treating process and prognosis of 10 critical SARS patients.Results5 had the underlying condition, 10 cases had used high doses of glucocorticoid and broad-spectrum antibiotics for a long time,all of them had acute respiratory function failure.After anti-infection ,ventilation support and other colligating therapies for about a month,4 cases had still acute respiratory function failure, CD4 and CD8 serum level of 8 cases was lower than the normal, 7 had secondary hyperglycemia ,2 had secondary hypertension,1 had severe malnutrition and electrolyte disturbance,1 had psyche and behaviour disorder,3 had pneumothorax; 8 had hospital acquired pneumonia, 3 of 8 developed to be mutiple organ dysfunction syndrome;total mortality was 30%(3/10). ConclusionThere were many complications at the anaphase of the critical SARS patients; The major causes that induced complication included chronic underlying condition ,defected immunity,long use of high doses of glucocorticoid and broad-spectrum antibiotics;the key to treat patients at the anaphase of the critical SARS were to treat actively the underlying diseases and complications,to improve immunity, and to use reasonable antibiotics and glucocorticoid.

Huang Ke-wu

Papers

Complications at the anaphase of the critical severe acute respiratory syndrome and its treating strategies