Is amoxicillin (amoxicillin) effective in treating COVID-19 (coronavirus disease 2019)?

Amoxicillin is Not Effective for COVID-19 Treatment

Amoxicillin should not be used for the treatment of COVID-19 unless there is clear evidence of bacterial co-infection, as COVID-19 is a viral illness and antibiotics have no direct antiviral activity against SARS-CoV-2. 1

Bacterial Co-infections in COVID-19

• Bacterial co-infections are rare in COVID-19 patients, occurring in only about 15.3% of hospitalized patients who receive empiric antibiotics 2
• Routine empirical antibiotic therapy is not recommended for patients with confirmed COVID-19 pneumonia 1, 3
• The risk of bacterial co-infections is higher in:
  • Critically ill patients admitted to ICU 1, 4
  • Elderly patients in long-term care facilities 5
  • Children younger than five years with moderate symptoms 5
  • Patients with significant comorbidities 5

Appropriate Use of Antibiotics in COVID-19

• Antibiotic therapy should only be considered when there is:

  • High clinical suspicion of bacterial co-infection 1
  • Radiological findings compatible with bacterial pneumonia 1
  • Elevated inflammatory markers suggesting bacterial infection 1
  • Positive urinary pneumococcal antigen testing 1
  • Positive blood or sputum cultures 1

• If antibiotics are deemed necessary for suspected bacterial co-infection:

  • Obtain blood and sputum cultures before starting antibiotics 1, 3
  • Consider procalcitonin testing - a low value (<0.25 ng/mL) supports withholding antibiotics 1, 3
  • Follow local guidelines for community-acquired pneumonia treatment 1
  • For mild to moderate community-acquired pneumonia with suspected bacterial co-infection, amoxicillin may be appropriate 1
  • Discontinue antibiotics after 48 hours if cultures are negative and the patient is improving 1
  • Limit treatment duration to 5 days if bacterial co-infection is confirmed 1

Risks of Inappropriate Antibiotic Use

• Indiscriminate use of antibiotics in COVID-19 patients contributes to:
  • Antimicrobial resistance 2, 6
  • Risk of Clostridioides difficile infection 5
  • Adverse drug reactions including kidney damage 5
  • Gastrointestinal side effects 2
  • Unnecessary healthcare costs 2

Evidence Against Antibiotics for COVID-19

• A Cochrane systematic review found no evidence supporting antibiotics as antiviral treatment for COVID-19 6
• Multiple studies have shown high rates of empiric antibiotic use (up to 59.6%) despite low rates of confirmed bacterial co-infection 2, 4
• Clinical trials have not demonstrated efficacy of antibiotics like azithromycin for treating COVID-19 itself 6

Conclusion

Amoxicillin and other antibiotics should not be routinely prescribed for COVID-19 patients without evidence of bacterial co-infection. Diagnostic testing including procalcitonin, blood cultures, and sputum cultures should guide antibiotic use decisions. When bacterial co-infection is confirmed, amoxicillin may be appropriate for mild to moderate community-acquired pneumonia, but should be discontinued if cultures are negative and the patient is improving.