Аннотация
В статье представлен критический анализ существующей в российском и зарубежном здравоохранении тактики использования антибиотиков в лечении больных COVID-19, обсуждаются возможные причины необоснованной антибиотической агрессии у данной категории пациентов. Анализируются потенциальные негативные последствия повсеместного применения антибиотиков у пациентов, переносящих новую коронавирусную инфекцию: угрожающая жизни больных кардиотоксичность при одновременном назначении такой «популярной» кандидатной этиотропной терапии как комбинация азитромицина и гидроксихлорохина, потенциальное развитие других серьезных нежелательных лекарственных реакций (в частности, развитие антибиотик-ассоциированного псевдомембранозного колита и др.), ожидаемый значительный рост вторичной лекарственной устойчивости потенциально патогенных микроорганизмов к широко и часто назначаемым антибиотикам.
ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России, Москва, Россия
-
1.
Zhou F., Yu T., Du R., Fan G., Liu Y., Liuet Z., et al. Clinical course, and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;28:395(10229):1054-1062.
DOI: 10.1016/S0140-6736(20)30566-3
-
2.
Ruan Q., Yang K., Wang W., Jiang L., Song J. Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China. Intensive Care Med. 2020;46:846-848.
DOI: 10.1007/s00134-020-05991-x
-
3.
Ahmed S., Jafri L., Hoodbhoy Z., Siddiqui I. Prognostic value of serum procalcitonin in COVID-19 patients: a systematic review. 2021;25(1):77-84.
DOI: 10.5005/jpjournals-10071-23706
-
4.
COVID-19 rapid guideline: antibiotics for pneumonia in adults in hospital. NICE guideline. Published: 1 May 2020. Available at: www.nice.org.uk/guidance/ng173. Accessed March, 2021.
-
5.
Borges do Nascimento I.J., Cacic N., Abdulazeem H.M., Caspar von Groote T., Jayarajah U., Weerasekaraet I., et al. Novel Coronavirus infection (COVID-19) in humans: a scoping review and meta-analysis. J Clin Med. 2020;9:941.
DOI: 10.3390/jcm9040941
-
6.
Ebell M.H., Chupp H., Cai X., Bentivegna M., Kearney M. Accuracy of signs and symptoms for the diagnosis of community-acquired pneumonia: a meta-analysis. Acad Emerg Med. 2020;27:541-553.
DOI: 10.1111/acem.13965
-
7.
Yap F.H.Y., Gomersall C.D., Fung K.S.C., Ho P.-L., Ho O.-M., Lam P.K.N., et al. Increase in methicillin-resistant Staphylococcus aureus acquisition rate and change in pathogen pattern associated with an outbreak of severe acute respiratory syndrome. Clin Infect Dis. 2004;39(4):511516.
DOI: 10.1086/422641
-
8.
So L.K., Lau A.C., Yam L.Y., Cheung T.M., Poon E., Yung R.W., Yuen K.Y. Development of a standard treatment protocol for severe acute respiratory syndrome. Lancet. 2003;361(9369):1615-1617.
DOI: 10.1016/s01406736(03)13265-5
-
9.
Ho W.; Hong Kong Hospital Authority Working Group on SARS, Central Committee of Infection Control. Guideline on management of severe acute respiratory syndrome (SARS). Lancet. 2003;361(9366):1313-1315.
DOI: 10.1016/s0140-6736(03)13085-1
-
10.
Smucny J.J., Becker L.A., Glazier R.H., McIsaac W. Are antibiotics effective treatment for acute bronchitis? A metaanalysis. J Fam Pract. 1998;47:453-460. PMID: 9866671
-
11.
Hueston W.J. Antibiotics: neither cost effective nor 'cough' effective. J Fam Pract. 1997;44:261-265. PMID: 9071245
-
12.
Munster V.J., Koopmans M., van Doremalen N., van Riel D., de Wit E. A novel coronavirus emerging in China – key questions for impact assessment. N Engl J Med. 2020;382(8):692-694.
DOI: 10.1056/NEJMp2000929
-
13.
Lupia T., Scabini S., Pinna S.M., Di Perri G., De Rosa F.G., Corcione S. 2019 novel coronavirus (2019-nCoV) outbreak: a new challenge. J Glob Antimicrob Resist. 2020;21:22-27.
DOI: 10.1016/j.jgar.2020.02.021
-
14.
Synopalnikov A.I. Definition, classification and epidemiology of community-acquired pneumonia. In book: Clinical guidelines. Community-acquired pneumonia in adults. Eds. Chuchalin A.G., Synopalnikov A.I. M.: Atmosfera; 2005. P. 7-14. Russian. (Синопальников А.И. Определение, классификация и эпидемиология внебольничной пневмонии. В кн.: Клинические рекомендации. Внебольничная пневмония у взрослых. Под ред. Чучалина А.Г., Синопальникова А.И. М.: Атмосфера; 2005. С. 7-14.)
-
15.
Chuchalin A.G., Sinopalnikov A.I., Stratchounski L.S., Kozlov R.S., Rachina S.A., Yakovlev S.V. Communityacquired pneumonia in adults: guidelines on diagnosis, treatment and prophylaxis. Klinicheskaja mikrobiologija i antimikrobnaja himioterapija. 2006;8(1):54-86. Russian. (Чучалин А.Г., Синопальников А.И., Страчунский Л.С., Козлов Р.С., Рачина С.А., Яковлев С.В. Внебольничная пневмония у взрослых: практические рекомендации по диагностике, лечению и профилактике. Клиническая микробиология и антимикробная химиотерапия. 2006;8(1):54-86.)
-
16.
Temporary guidelines. Prevention, diagnosis and treatment of new coronavirus infection (COVID-19). Version 10 (08.02.2021). Available at: www.minzdrav.gov.ru. Accessed February, 2021. Russian. (Временные методические рекомендации. Профилактика, диагностика и лечение новой коронавирусной инфекции (COVID-19). Версия 10 (08.02.2021). Доступно по адресу: www.minzdrav.gov.ru. Ссылка активна на февраль 2021 г.)
-
17.
Zaitsev A.A., Chernov S.A., Stets V.V., Patsenko M.B., Kudriashov O.I., Chernetsov V.A., Kriukov E.V. Algorithms for the management of patients with a new coronavirus COVID-19 infection in a hospital. Guidelines. Consilium Medicum. 2020;22(11):91-97. Russian. (Зайцев А.А., Чернов С.А., Стец В.В., Паценко М.Б., Кудряшов О.И, Чернецов В.А., Крюков Е.В. Алгоритмы ведения пациентов с новой коронавирусной инфекцией COVID-19 в стационаре. Методические рекомендации. Consilium Medicum. 2020;22(11):91-97.)
DOI: 10.26442/20751753.2020.11.200520
-
18.
Gao Z., Xu Y., Sun C., Wang X., Guo Y., Qiu S., Ma K. A systematic review of asymptomatic infections with COVID-19. J Microbiol Immunol Infect. 2021;54(1):1216.
DOI: 10.1016/j.jmii.2020.05.001
-
19.
Lai C.-C., Liu Y.H., Wang C.-Y., Wang Y.-H., Hsueh S.-C., Yen M.-Y., et al. Asymptomatic carrier state, acute respiratory disease, and pneumonia due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2): facts and myths. J Microbiol Immunol Infect. 2020;53:404-412.
DOI: 10.1016/j.jmii.2020.02.012
-
20.
Menni C., Valdes A., Freydin M.B., Ganesh S., El-Sayed Moustafa J.S., Visconti A., et al. Loss of smell and taste in combination with other symptoms is a strong predictor of COVID-19 infection. medRxiv 2020.04.05.20048421.
DOI: 10.1101/2020.04.05.20048421
-
21.
Li Y., Wang J., Wang C., Yang Q., Xu Y., Xu J., et al. Characteristics of respiratory virus infection during the outbreak of 2019 novel coronavirus in Beijing. Int J Infect Dis. 2020;96:266-269.
DOI: 10.1016/j.ijid.2020.05.008
-
22.
Zhou F., Yu T., Du R., Fan G., Liu Y., Liuet Z., et al. Clinical ciurse and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395:1054-1062.
DOI: 10.1016/S01406736(20)30566-3
-
23.
Ruan Q., Yang K., Wang W., Jiang L., Song J. Clinical predictors of martality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China. Intensive Care Med. 2020;46:846-848.
DOI: 10.1007/s00134-020-05991-x
-
24.
Metlay J.P., Waterer G.W., Long A.C., Anzueto A., Brozek J., Crothers K., et al. Diagnosis and treatment of adults with community-acquired pneumonia. an official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019;200:e45-e67.
DOI: 10.1164/rccm.201908-1581ST
-
25.
Rule J.A., Hynan L.S., Attar N., Sanders C., Korzun W.J., Lee W.M., et al. Procalcitonin identifies cell injury, not bacterial infection, in acute liver failure. PLoS One. 2015;10(9):e0138566.
DOI: 10.1371/journal.pone.0138566
-
26.
Kucirka L.M., Lauer S.A., Laeyendecker O., Boon D., Lessleret J. Variation in false-negative rate of reverse transcriptase polymerase chain reaction-based SARSCoV-2 tests by time since exposure. Ann Intern Med. 2020;173:262-267.
DOI: 10.7326/M20-1495
-
27.
Fang Y., Zhang H., Xie J., Lin M., Ying L., Pang P., Ji W. Sensitivity of chest CT for COVID-19: comparison to RTPCR. Radiology. 2020;296:E115-E117.
DOI: 10.1148/radiol.2020200432
-
28.
Blažić I., Brkljačić B., Frija G. The use of imaging in COVID-19-results of a global survey by the International Society of Radiology. Eur Radiol. 2021;31:1185-1193.
DOI: 10.1007/s00330-020-07252-3
-
29.
Thoracic Imaging in COVID-19 infection. Guidance for the reporting radiologist British Society Thoracic Imaging. Version 1. 2020. Available at: www.bsti.org.uk. Accessed March, 2021.
-
30.
Duzgun S.A., Durhan G., Demirkazik F.B., Akpinar M.G., Ariyurek O.M. COVID-19 pneumonia: the great radiological mimicker. Insights Imaging. 2020;11:118.
DOI: 10.1186/s13244-020-00933-z
-
31.
Caruso D., Zerunian M., Polici M., Pucciarelli F., Polidori T., Rucci C., et al. Chest CT features of COVID-19 in Rome, Italy. Radiology. 2020;296:E79-E85.
DOI: 10.1148/radiol.2020201237
-
32.
Simpson S., Kay F.U., Abbara S., Bhalla S., Chung J.H., Chunget M., et al. Radiological Society of North America Expert Consensus Statement on Reporting Chest CT Findings Related to COVID-19. Endorsed by the Society of Thoracic Radiology, the American College of Radiology, and RSNA. J Thorac Imaging. 2020;35(4):219-227.
DOI: 10.1097/RTI.0000000000000524
-
33.
Gupta R.K., George R., Nguyen-Van-Tam J.S. Bacterial pneumonia and pandemic influenza planning. Emerg Infect Dis. 2008;14:1187-1192.
DOI: 10.3201/eid1408.070751
-
34.
Morris D.E., Cleary D.W., Clakke S.C. Secondary bacterial infections associated with influenza pandemics. Front Microbiol. 2017;8:1041.
DOI: 10.3389/fmicb.2017.01041
-
35.
Morens D.M., Taubenberger J.K., Fauci A.S. Predominant role of bacterial pneumonia as a cause of death in pandemic influenza: implications for pandemic influenza preparedness. J Infect Dis. 2008;198:962-970.
DOI: 10.1086/591708
-
36.
Zambon M.C. The pathogenesis of influenza in humans. Rev Med Virol. 2001;11:227-241.
DOI: 10.1002/rmv.319
-
37.
Klein E.Y., Monteforte B., Gupta A., Jiang W., May L., Hsieh Y.-H., Dugas A. The frequency of influenza and bacterial coinfection: a systematic review and metaanalysis. Influenza Other Respir Viruses. 2016;10:394403.
DOI: 10.1111/irv.12398
-
38.
Centers for Disease Control and Prevention. Bacterial coinfection in lung tissue specimens from fatal cases of 2009 pandemic influenza A (H1N1) – United States, May-August 2009. Morb Mortal Wkly Rep. 2009;58:1071-1074. PMID: 19798021
-
39.
Gill J.R., Sheng Z.M., Ely S.F., Guinee D.G., Beasley M.B., Suh J., et al. Pulmonary pathologic findings of fatal 2009 pandemic influenza A/H1N1 viral infections. Arch Pathol Lab Med. 2010;134:235-243.
DOI: 10.1043/15432165-134.2.235
-
40.
Weinberger D.M., Simonsen .L, Jordan R., Steiner C., Miller M., Viboudet C., et al. Impact of the 2009 influenza pandemic on pneumococcal pneumonia hospitalizations in the United States. J Infect Dis. 2012;205:458-465.
DOI: 10.1093/infdis/jir749
-
41.
Lansbury L., Lim B., Baskaran V., Lim W.S. Co-infections in people with COVID-19: a systematic review and metaanalysis. J Infect. 2020;81:266-275.
DOI: 10.1016/j.jinf.2020.05.046
-
42.
Garcia-Vidal C., Sanjuan G., Moreno-García E., Puerta-Alcalde P., Garcia-Pouton N., Chumbitaet M., et al. Incidence of co-infections and superinfections in hospitalized patients with COVID-19: a retrospective cohort study. Clin Microbiol Infect. 2021;27:83-88.
DOI: 10.1016/j.cmi.2020.07.041
-
43.
Rawson T.M., Moore L.S.P., Zhu N., Ranganathan N., Skolimowska K., Gilchrist M., et al. Bacterial and fungal coinfection in individuals with coronavirus: a rapid review to support COVID-19 antimicrobial prescribing. Clin Infect Dis. 2020;71:2459-2468.
DOI: 10.1093/cid/ciaa530
-
44.
Hughes S., Troise O., Donaldson H., Mughal N., Moore L.S.P. Bacterial and fungal coinfection among hospitalized patients with COVID-19: a retrospective cohort study in a UK secondary-care setting. Clin Microbiol Infect. 2020;26(10):1395-1399.
DOI: 10.1016/j.cmi.2020.06.025
-
45.
Zhou F., Yu T., Du R., Fan G., Liu Y., Liuet Z., al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054-1062.
DOI: 10.1016/S0140-6736(20)30566-3
-
46.
Rawson T.M., Wilson R.C., Holmes A. Understanding the role of bacterial and fungal infection in COVID-19. Clin Microbiol Infect. 2021;27(1):9-11.
DOI: 10.1016/j.cmi.2020.09.025
-
47.
Gautret P., Lagier J.-C., Parola P., Hoang V.T., Meddeb L., Mailhe M., et al. Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an openlabel non-randomized clinical trial. Int J Antimicrob Agents. 2020;56:105949.
DOI: 10.1016/j.ijantimicag.2020.105949
-
48.
RECOVERY Collaborative Group. Azithromycin in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial. Lancet. 2021;397(10274):605-612.
DOI: 10.1016/S01406736(21)00149-5
-
49.
WHO Solidarity Trial Consortium; Pan H., Peto R., Henao-Restrepo A.M., Preziosi M.-P., Sathiyamoorthy V., Abdool Karim Q. Repurposed antiviral drugs for Covid-19 interim WHO Solidarity Trial results. N Engl J Med. 2021;384(6):497-511.
DOI: 10.1056/NEJMoa2023184.
-
50.
RECOVERY Collaborative Group; Horby P., Mafham M., Linsell L., Bell J.L., Staplin N., Emberson J.R., et al. Effect of hydroxychloroquine in hospitalized patients with Covid-19. N Engl J Med. 2020;383:2030-2040.
DOI: 10.1056/NEJMoa2022926
-
51.
Molina J.M., Delaugerre C., Le Goff J. , Mela-Lima B., Ponscarme D., Goldwirt L., de Castro N. No evidence of rapid antiviral clearance or clinical benefit with the combination of hydroxychloroquine and azithromycin in patients with severe COVID-19 infection. Med Mal Infect. 2020;50:384.
DOI: 10.1016/j.medmal.2020.03.006
-
52.
Cavalcanti A.B., Zampieri F.G., Rosa R.G., Azevedo L.C.P., Veiga V.C., Avezum A., et al. Hydroxychloroquine with or without azithromycin in mild-to-moderate Covid-19. N Engl J Med. 2020;383:2041-2052.
DOI: 10.1056/NEJMoa2019014
-
53.
Fiolet T., Guihur A., Rebeaud M.E., Mulot M., PeifferSmadja N., Mahamat-Saleh Y. Effect of hydroxychloroquine with or without azithromycin on the mortality of coronavirus disease 2019 (COVID-19) patients: a systematic review and meta-analysis. Clin Microbiol Infect. 2021;27(1):1927.
DOI: 10.1016/j.cmi.2020.08.022
-
54.
Tisdale J.E. In: Wiggins B.S., Sanoski C.A., Eds. Emergency cardiovascular pharmacotherapy. A point of care guide. 2012: pp. 23, 38.
-
55.
Owens R.C. Jr. QT Prolongation with antimicrobial agents understanding the significance. Drugs. 2004;64:10911124.
DOI: 10.2165/00003495-200464100-00005
-
56.
Kim M.H., Berkowitz C., Trohman R.G. Polymorphic ventricular tachycardia with a normal QT interval following azithromycin. Pacing Clin Electrophysiol. 2005;28:12211222.
DOI: 10.1111/j.1540-8159.2005.50146.x
-
57.
Naksuk N., Lazar S., Peeraphatdit T.B. Cardiac safety of off-label COVID-19 drug therapy: a review and proposed monitoring protocol. Eur Heart J Acute Cardiovasc Care. 2020;9:215-221.
DOI: 10.1177/2048872620922784
-
58.
Mercuro N.J., Yen C.F., Shim D.J., Maher T.R., McCoy C.M., Zimetbaum P.J., Gold H.S. Risk of QT interval prolongation associated with use of hydroxychloroquine with or without concomitant azithromycin among hospitalized patients testing positive for Coronavirus Disease 2019 (COVID-19). JAMA Cardiol. 2020;5(9):1036-1041.
DOI: 10.1001/jamacardio.2020.1834
-
59.
Brown K.A., Khanafer N., Daneman N., Fisman D.N. Metaanalysis of antibiotics and the risk of communityassociated Clostridium difficile infection. Antimicrob Agents Chemother. 2013;57:2326-2332.
DOI: 10.1128/AAC.02176-12
-
60.
Sandhu A., Tillotson G., Polistico J., Salimnia H., Cranis M., Moshos J., et al. Clostridiodes difficile in COVID-19 patients, Detroit, Michigan, USA, March–April 2020. Emerg Infect Dis. 2020;26:2272-2274.
DOI: 10.3201/eid2609.202126
-
61.
Lewandowski K., Rosołowski M., Kaniewska M., Kucha P., Meler A., Wierzba W., Rydzewska G. Clostridioides difficile infection in coronavirus disease 2019 (COVID-19): an underestimated problem? Pol Arch Intern Med 2021;131:121-127.
DOI: 10.20452/pamw.15715
-
62.
Murray A.K. The novel coronavirus COVID-19 outbreak: global implications for antimicrobial resistance. Front Microbiol. 2020;11:1020.
DOI: 10.3389/fmicb.2020.01020
-
63.
ISARIC. International Severe Acute Respiratory and Emerging Infections Consortium (ISARIC); 2020. Available at: https://isaric.tghn.org/. Accessed March, 2021.
-
64.
Langford B.J., So M., Raybardhan S., Leung V., Soucy J.-P., Westwood D., et al. Antibiotic prescribing in patients with COVID-19: rapid review and meta-analysis. Clin Microbiol Infect. 2021;1:18.
DOI: 10.1016/j.cmi.2020.12.018
-
65.
George P.M., Barratt S.L., Condliffe R., Desai S.R., Devaraj A., Forrest I., et al. Respiratory follow-up of patients with COVID-19 pneumonia. Thorax. 2020;75:10091016.
DOI: 10.1136/thoraxjnl-2020-215314
-
66.
Zhao Y.-M., Shang Y.-M., Song W.-B., Li Q.-Q., Xie H., Xu Q.-F., et al. Follow-up study of the pulmonary function and related physiological characteristics of COVID-19 survivors three months after recovery. EClinicalMedicine. 2020;25:100463.
DOI: 10.1016/j.eclinm.2020.100463
-
67.
Sieswerda E., de Boer M.G.J., Bonten M.M.J., Boersma W.G., Jonkers R.E., Aleva R.M., et al. Recommendations for antibacterial therapy in adults with COVID-19 – an evidence-based guideline. Clin Microbiol Infect. 2021;27(1):61-66.
DOI: 10.1016/j.cmi.2020.09.041