From the Guidelines
Oral antibiotics such as amoxicillin, azithromycin, or fluoroquinolones, and oral steroids like prednisone, should be considered for treatment, especially if bacterial infection cannot be ruled out, as suggested by the most recent study 1. When considering treatment options, it's essential to weigh the potential benefits and risks. For oral antibiotics, common choices include:
- Amoxicillin (250-500mg three times daily for 7-10 days)
- Azithromycin (500mg on day 1, then 250mg daily for 4 days)
- Fluoroquinolones (500mg twice daily for 7-14 days) These antibiotics can help prevent or treat secondary bacterial infections, which can be challenging to diagnose in patients with COVID-19 1. For oral steroids, prednisone is frequently prescribed, typically starting at 40-60mg daily with a gradual taper over 1-2 weeks. Methylprednisolone dose packs (starting at 24mg and tapering over 6 days) are also commonly used 1. It's crucial to note that the use of oral antibiotics and steroids should be guided by the patient's clinical manifestations and the potential risk of bacterial complications, as highlighted in the study 1. The study also emphasizes the importance of considering the current special situation, where patients with COVID-19 may not have access to timely medical care, and the potential benefits of preventive treatment with oral antibiotics and steroids 1. In contrast, another study 1 discusses the use of macrolide antibiotics, such as azithromycin, for the prevention of acute exacerbations of COPD, but this is not directly relevant to the treatment of COVID-19. Therefore, based on the most recent and relevant study 1, the use of oral antibiotics and oral steroids is recommended for treatment, especially if bacterial infection cannot be ruled out.
From the FDA Drug Label
The first study consisted of 35 pediatric patients treated with 20 mg/kg/day (maximum daily dose 500 mg) for 3 days of whom 34 patients were evaluated for pharmacokinetics. Following prolonged therapy, withdrawal of corticosteroids may result in symptoms of the corticosteroid withdrawal syndrome including, myalgia, arthralgia, and malaise.
Oral Antibiotics and Oral Steroids:
- Azithromycin (PO): can be used as an oral antibiotic, with a maximum daily dose of 500 mg.
- Prednisone (PO): can be used as an oral steroid, with dosage adjustments required for antidiabetic agents, and monitoring of coagulation indices when co-administered with warfarin. 2 3
From the Research
Oral Antibiotics
- Azithromycin 500 mg once daily for 3 days is equivalent to a 10-day treatment with clarithromycin 500 mg twice daily in adult patients with acute exacerbation of chronic bronchitis (AECB) 4
- Azithromycin 1 g once daily for 3 days is at least as effective as amoxicillin-clavulanate 875/125 mg twice daily for 7 days in the treatment of adult patients with community-acquired pneumonia 5
- Cefditoren pivoxil 200 and 400 mg BID for 14 days is equivalent to amoxicillin/clavulanate 875/125 mg BID for 14 days in adult outpatients with community-acquired pneumonia (CAP) 6
- Azithromycin for 5 days is effective in the treatment of community-acquired pneumonia in children, with a satisfactory therapeutic outcome similar to those of amoxicillin/clavulanate or erythromycin given three times a day for 10 days 7
Oral Steroids
- There are no research papers provided to assist in answering this question regarding oral steroids.
Additional Information
- Azithromycin has adequate tissue levels for 7 days with a 3-day treatment regimen and produces a "focused" cure, making it an appropriate antibiotic for dental infections 8