Table 1 The use of antibiotics in COVID-19 management in 10 African countries
Country | List of antibiotics recommended in the guideline | Scenario for recommendation | Compliance with WHO guideline | Guideline references (accessed 4 June 2021) |
|---|---|---|---|---|
Ghana | Azithromycin, doxycycline | Recommended for use in the management of confirmed cases (with asymptomatic, mild, or moderate symptoms) | -WHO does not recommend antibiotic use in suspected/mild/moderate COVID-19. -WHO does not recommend azithromycin with/without hydroxychloroquine in the management of COVID-19. -WHO does not encourage the use of broad-spectrum antibiotics for COVID-19 especially those on the Watch and Reserve List. | https://www.moh.gov.gh/wp-content/uploads/2016/02/COVID-19-STG-JUNE-2020-1.pdf |
Kenya | Amoxicillin, amoxicillin-clavulanic acid, erythromycin, azithromycin, clarithromycin | Recommended for use in the management of severe COVID-19 and sepsis. Empirical use of antimicrobials for all severe acute respiratory infections and should be de-escalated on the basis of microbiology results and clinical judgment | -WHO does not recommend azithromycin with/without hydroxychloroquine in the management of COVID-19 - WHO does not encourage the use of broad-spectrum antibiotics for COVID-19 especially those on the Watch and Reserve List. | https://kma.co.ke/Documents/Case%20management%20protocol.pdf |
Uganda | Azithromycin and amoxicillin (moderate COVID-19); ceftriaxone, ampicillin, gentamicin, benzylpenicillin, and azithromycin (severe COVID-19 pneumonia); and azithromycin, piperacillin/tazobactam (critically ill COVID-19 patient) | Empiric use of antibiotics is recommended for sepsis in COVID-19 patient as well as in moderate, severe, and critically ill COVID-19 patient and de-escalated on the basis of microbiology results and clinical judgment | -WHO does not recommend antibiotic use in mild/moderate COVID-19. -WHO does not encourage the use of broad-spectrum antibiotics for COVID-19 especially those on the Watch and Reserve List. | |
Nigeria | No specific antibiotic was stated in the treatment guideline for COVID-19. However, broad-spectrum antibiotics based on local epidemiology were recommended for some cases | Prophylactic/empiric use of antibiotics is not recommended in asymptomatic and mild COVID-19 cases. For severe COVID-19 cases, the choice of antibiotics should be based on the clinical diagnosis, local epidemiology, and antibiotic susceptibility | The country’s guideline complies with WHO treatment guidelines for COVID-19 and does not list any specific antibiotic for use in COVID-19 management. | |
South Africa | Ceftriaxone and azithromycin | Empirical use of antibiotics is recommended for co-infections such as conventional community-acquired pneumonia or atypical pneumonia | WHO does not encourage the use of broad-spectrum antibiotics for COVID-19 especially those on the Watch and Reserve List. | |
Zimbabwe | Ceftriaxone and azithromycin | Recommend that antimicrobial therapy should not be delayed just to collect blood culture. Empiric antibiotics are recommended | WHO does not encourage the use of broad-spectrum antibiotics for COVID-19 especially those on the Watch and Reserve List. | |
Botswana | Amoxicillin-clavulanic acid and azithromycin (suspected/confirmed COVID-19 cases) | If clinical suspicion for co-infection exists, consider empirical antimicrobials to treat co-pathogens causing the syndrome | -WHO does not encourage the use of broad-spectrum antibiotics for COVID-19 especially those on the Watch and Reserve List. -WHO does not recommend antibiotic use in mild/moderate/suspected COVID-19. -WHO does not recommend azithromycin alone or with/without hydroxychloroquine in the management of COVID-19. | |
Liberia | Amoxicillin-clavulanic acid, azithromycin, amoxicillin (moderate COVID-19) and amoxicillin-clavulanic, gentamicin, doxycycline acid, azithromycin, and ampicillin (severe COVID-19). Fluoroquinolones, e.g., ciprofloxacin with or without metronidazole in COVID-19-related symptoms. | Empiric use of antibiotic (broad spectrum) is recommended for severe and mild case. For COVID-19-associated sepsis, laboratory findings such as blood cultures, sputum culture, chest X-ray, examination of line sites, etc. are recommended to guide antibiotic selection. Antibiotics are also recommended for sore throat in mild/moderate COVID-19, as well as cough, and diarrhea. | WHO does not encourage the use of broad-spectrum antibiotics for COVID-19 especially those on the Watch and Reserve List. -WHO does not recommend antibiotic use in mild/moderate/suspected COVID-19. -WHO does not recommend azithromycin or with/without hydroxychloroquine in the management of COVID-19. | http://moh.gov.lr/wp-content/uploads/Interim_Guidance_for_care_of_Pts_with_Covid_19_in_Liberia.pdf |
Ethiopia | Amoxicillin-clavulanic acid or amoxicillin (moderate COVID-19) and ceftazidime/cefepime and/or vancomycin or meropenem (other carbapenems) ± vancomycin (severe/critical COVID-19). Recommended antibiotics in pediatrics also include gentamicin, ampicillin, ceftriaxone/cefotaxime, azithromycin, and meropenem | Antibiotics (preferably broad spectrum) are recommended for empiric use based on physician judgment after taking a sample for blood culture, in severe COVID-19 cases | WHO does not encourage the use of broad-spectrum antibiotics for COVID-19 especially those on the Watch and Reserve List. -WHO does not recommend antibiotic use in mild/moderate/suspected COVID-19. -WHO does not recommend azithromycin or with/without hydroxychloroquine in the management of COVID-19. | |
Rwanda | Doxycycline, amoxicillin, amoxicillin-clavulanic acid (moderate and mild COVID-19), clarithromycin, amoxicillin-clavulanic acid, cefuroxime, ceftriaxone, or levofloxacin [if allergy to penicillin] (severe and critical COVID-19) | Recommend antibiotics for highly suspected pneumonia based on clinical signs in moderate/mild COVID-19, prevention of secondary bacterial infection, and ventilator-associated pneumonia in severe/critically ill COVID-19 patient | -WHO does not recommend the use of antibiotics in mild/moderate COVID-19. |