JAMA Netw Open

Antibiotics don’t appear to offer benefit in nonsevere COVID-19 hospitalizations

May 21, 2025

Study details: This population-based cohort study used target trial emulation to assess whether antibiotic treatment improves outcomes in patients hospitalized with nonsevere COVID-19. The analysis included 520,405 adult, immunocompetent patients admitted for nonsevere COVID-19 to 1,053 U.S. hospitals from April 2020 to December 2023. The primary outcome was a composite of clinical deterioration (vasopressor use, high-flow oxygen, noninvasive/invasive ventilation, intermediate/ICU admission) or in-hospital mortality from day two onward. Propensity methods adjusted for confounders.

Results: Of the cohort, 30.8% received community-acquired pneumonia (CAP)-targeted antibiotics on admission. Patients given antibiotics on day one of hospitalization had slightly higher rates of deterioration or death (20.8% vs 18.4%), though the difference wasn’t clinically meaningful. Adjusted analyses showed a small but statistically significant increase in odds of poor outcomes with antibiotics (propensity-matched odds ratio, 1.03, 95% confidence interval, 1.01–1.05). No clinically meaningful benefit was observed.

Clinical impact: Early antibiotic therapy doesn’t improve clinical outcomes in patients hospitalized for nonsevere COVID-19 and may be associated with harm. Given the risks of unnecessary antibiotic use—including adverse events and antimicrobial resistance—these results strongly argue against routine empiric antibiotics in this population.

Source:

Pulia MS, et al. JAMA Netw Open. Antibiotic Treatment in Patients Hospitalized for Nonsevere COVID-19. https://pubmed.ncbi.nlm.nih.gov/40388163/