Background: COVID-19 patients are typically prescribed antibiotics empirically despite concerns. There is a need to evaluate antibiotic use among hospitalized COVID-19 patients during successive pandemic waves in Pakistan alongside co-infection rates.

Methods: Retrospective review of pa-tient records among five tertiary care hospitals during successive waves. Data collected from confirmed COVID-19 patients during first five waves.

Results: 3,221 patients were included. The majority were male (51.53%), resident in urban areas (56.35%) and aged >50 years (52.06%). Cough, fever, and sore throat were clinical symptoms in 20.39%, 12.97% and 9.50% respectively. 23.62% of COVID-19 patients presented with typically mild disease and45.48% with moderate disease. High prevalence of antibiotic prescribing (89.69%), averaging 1.66 antibiotics per patient despite only 1.14% bacterial co-infections and 3.14% secondary infections. Antibiotics use significantly increased with increasing severity, elevated WBCs and CRP levels, need for oxygen and admittance to ICUs; however, decreased significantly after the second wave (p < 0.001). Commonly prescribed antibiotics were piperacillin plus enzyme inhibitor (20.66%), azithromycin (17.37%) and meropenem (15.45%). Common pathogens were Staphylococcus aureus (24.19%) and Streptococcus pneumoniae (20.96%). The majority of the prescribed antibiotics (93.35%) were from WHO “Watch” category.

Conclusion: Excessive prescribing of antibiotics is still occurring among COVID-19 patients in Pakistan; however, rates are reducing. Urgent measures are needed for further reductions.


This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).

Cite as

Ramzan, K., Shafiq, S., Raees, I., Mustafa, Z., Salman, M., Khan, A., Meyer, J. & Godman, B. 2022, 'Co-infections, secondary infections, and antimicrobial use in patients hospitalized with COVID-19 during the first five waves of the pandemic in Pakistan; findings and implications', Antibiotics, 11(6), article no: 789. https://doi.org/10.3390/antibiotics11060789

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Last updated: 16 June 2022
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