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New research explores a novel COVID-19 treatment combination involving antibiotics. nevodka/Getty Images
  • A small study suggests that treating patients who have moderate or severe COVID-19 with ceftazidime or cefepime, plus the steroid dexamethasone, is as effective as standard care.
  • The antibiotic-plus-steroid treatment was associated with fewer side effects compared with standard care, which can involve seven or more different drugs.
  • Lab tests and computer simulations found 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 overuse promotes antibiotic resistance.

Healthcare professionals are always keen to stress that antibiotics are ineffective against viral infections, with some rare exceptions.

Antibiotics have saved the lives of millions of people since they came into widespread use early in the 20th century, but overuse accelerates the evolution of bacterial resistance to the drugs.

According to the Centers for Disease Control and Prevention (CDC), there are more than 2.8 million cases of antibiotic-resistant infection and 35,000 resulting deaths annually in the United States alone.

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Therefore, there are serious concerns that overprescribing antibiotics to patients with COVID-19 — in the absence of any evidence of a bacterial coinfection — promotes the spread of antibiotic resistance.

In the United Kingdom, the National Institute for Health and Care Excellence reports that under 8% of people hospitalized with COVID-19 also have a bacterial infection.

But one study in the U.K. found that around 85% of COVID-19 patients receive treatment with an antibiotic during their hospital stay.

During the pandemic, there had been early hopes that the antibiotic azithromycin might be an effective treatment for COVID-19. However, a recent Cochrane review of clinical trials found no evidence for this.

So the findings of a small study that suggests either 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 to Beni-Suef University Hospital in Beni Suef, Egypt.

Researchers randomly assigned the patients to three groups:

  • treatment with cefepime plus dexamethasone: 124 patients
  • treatment with ceftazidime plus dexamethasone: 136 patients
  • standard COVID-19 treatment, as recommended in World Health Organization (WHO) guidelines and the Egyptian management protocol, with seven or more drugs: 110 patients

The mean recovery time for patients receiving treatment with cefepime or ceftazidime was 12 days and 13 days, respectively, while 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 insufficient numbers of patients in each group to draw firm conclusions.

However, they also conducted lab tests and computer simulations, which suggested that these two antibiotics inhibit the activity of a protease enzyme called Mpro. Mpro is an important part of a virus’s life cycle — a reduced activity of the enzyme impairs the replication rate of the virus.

The study appears in the journal Antibiotics.

Cefepime and ceftazidime are broad-spectrum, beta-lactam antibiotics in the class known as cephalosporins. Both are on the WHO’s AWaRe watchlist, meaning there is a high potential for bacteria to develop resistance to them.

However, in their paper, the researchers argue that using existing antibiotics with proven antiviral potential against COVID-19 could actually delay the emergence of antibiotic resistance.

Ahmed M. Sayed, Ph.D., a pharmacist at Nahda University in Beni Suef and one of the authors, told Medical News Today that using 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 need antibiotics coverage,” said Dr. Sayed.

“Accordingly, if we use only a certain set of broad-spectrum antibiotics — that have additional antiviral potential like the two studied antibiotics in our article — in such types of infections, we will save, to some extent, other essential 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 coinfections will make these other drugs more ineffective.

In contrast, drugs, such as cefepime and ceftazidime, which may have multiple therapeutic benefits, could reduce the number of other necessary treatments and their associated side effects.

The authors acknowledge that their study only involved a single hospital and was too small to draw firm 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 of these antibiotics that will involve a larger number of patients and be more likely to provide statistically significant findings.

In their paper, the researchers also note that their computer simulations and lab results could provide helpful leads for designing more potent antiviral drugs that target the Mpro enzyme of SARS-CoV-2.

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