Since December, 2019 the koronavirusny infection (COVID-19) which is caused by a virus heavy acute respiratory sindroma2 (SARS-CoV–2) extended worldwide. The arisen pandemic became serious test for the existing system of the world health care, partly it is connected with the fact that if in treatment of more earlier found heavy acute respiratory syndrome (SARS-CoV) and a coronavirus of a Middle Eastern respiratory syndrome (MERS-CoV) doctors have an experience, really effective methods of treatment COVID-19 do not exist today.
At the moment there was a practice of treatment of COVID-19 antibiotics. Already there were reviews devoted to this subject and data continue to collect. Researches continue and the recent analysis showed that bacterial and fungal multi-infections were present only at 8% of patients with COVID-19, but despite this fact, about 72% received therapy by antibiotics. One of the reasons of this therapeutic approach can be the fact that clinical symptoms of COVID-19 are similar to symptoms of bacterial pneumonia, such as cough, high temperature of a body and fatigue. Besides, at patients corresponding changes of blood are observed, in particular, 44.3% of patients with COVID-19 had increase in S-jet protein.
If diagnostics of an infection is complicated, in most cases doctors appoint empirical or preventive treatment antibiotics. In national leaders and descriptions of series of cases information on expediency of use of antibiotics of a broad spectrum of activity and also on potential benefit of the antibiotics active is provided on atypical activators.
It is known that the confirmed diagnosis of COVID-19 of heavy degree is a basic reason of death of patients already in itself. At an initial stage of a disease most of patients with COVID-19 have poorly expressed symptomatology which besides can be very different. At hospitalization not heavy patients had not expressed COVID-19 symptoms, but also, obtaining test results from laboratory sometimes takes time. Therefore during a pandemic, for the purpose of prevention of consecutive bacterial infections and also in connection with increase in number of patients with a medium-weight current, the decision to carry out empirical treatment of COVID-19 by antibiotics is often made.
At viral infections empirical or preventive treatment by antibiotics is considered disputable for a long time. Therefore now specialists need convincing data on whether treatment by antibiotics influences progressing and an outcome at patients with COVID-19. Unfortunately, this subject is insufficiently investigated. To represent the clinical bases for elaboration of strategy in respect of an antibioticotherapia, in China the retrospective cohort method of a research was applied. It was required to analyse action of antibiotics at patients with the medium-weight course of a koronavirusny infection within 48 hours after receipt in a hospital by the following criteria: a course of a disease, accession of consecutive bacterial infection, duration of finding of the patient in a hospital and lethality level.
According to a research, in the Chinese province of Hubei the total number of patients in four hospitals made 2501 patients. According to a method of inclusion exception in a research only 1613 patients, and 888 entered, respectively, were excluded. Among them 996 patients received antibacterial therapy within 48 hours on receipt in a hospital and 617 — did not receive or received, but after 48 hours of stay in clinic.
According to conclusions of authors, the conducted research showed that in the absence of proofs of a bacterial infection empirical or preventive treatment by antibiotics at an early stage promoted increase of risk of progressing of an infection, increased the frequency of accession of bacterial infections and also increased terms of hospitalization of patients. Besides, the essential difference in death rate at patients with moderate severity of COVID-19 which received antibacterial drugs at an early stage, and those who did not receive them was not revealed.
It was in passing established that the composition of intestinal microflora has a considerable impact on pulmonary immunity. In particular, it was shown that change of intestinal microflora reduces ability of lungs to protection against pathogenic microorganisms and increases their susceptibility to a viral infection. It is quite logical to assume that use of antibiotics for the infected SARS-CoV–2 can deepen disbioz intestinal microflora and by that to promote further injury of lungs. Thus, the disturbance of balance of intestinal microflora caused by reception of antibiotics at an early stage of a disease can also affect an aggravation of symptoms of patients from COVID-19.