Recommendations
➤ HCP should limit initiation of antibiotics — particularly
broad-spectrum agents — for patients in acute care settings
with high pre-test probability for a viral infection such as
SARS-CoV-2 or influenza, even if there is lack of readily
available and accurate diagnostics.
Diagnostic Testing
➤ HCP may perform inflammatory marker tests at baseline,
particularly in critically ill patients, including C-reactive
protein (CRP), lactate dehydrogenase, D-Dimer, serum
ferritin, and high-sensitivity troponin.
➤ HCP should repeat laboratory testing only to the extent that
it provides actionable clinical data.
➤ HCP can monitor CRP if clinically indicated to inform
respiratory viral treatments.
Note: For COVID-19, CRP monitoring informed use of biologic agents such as
tocilizumab or baricitinib.
➤ HCP should not use inflammatory markers as the basis for
initiation of antibiotics or antifungal agents since they may not
be indicative of bacterial co-infection.
• HCP should not use procalcitonin routinely to aid in the decision to
initiate antibiotics.
Note: HCP will need to monitor the relationship of inflammatory markers to
infection in future infectious epidemics and pandemics.
➤ HCP should not obtain bacterial cultures or respiratory
multiplex polymerase chain reaction (PCR) tests for patients
who do not have indicators consistent with bacterial infection,
particularly those with stable clinical status in a non-intensive
care unit (ICU) setting.
Note: It is important for HCP to identify patients who require empiric antibiotic
treatment despite low rates of co-infection on admission for COVID-19 and prior
respiratory viral pandemics.
