Antibiotics Do Not Cut Death Risk in Hospitalized Patients With Viral Respiratory Illnesses

Although adults hospitalized with COVID-19, the flu, or respiratory syncytial virus are often administered antibiotics, the drugs have no effect on reducing the risk of death, according to a new study.

Antibiotics do not reduce the risk of dying in adults hospitalized with COVID-19, the flu, or respiratory syncytial virus, suggests a new study.

The findings suggest that it would be justified to limit antibiotics in these instances, given the growing concern of antibiotic resistance, the researchers wrote.

The research will be presented next month at the European Congress of Clinical Microbiology & Infectious Diseases in Copenhagen, Denmark.

Respiratory infections account for around 10% of worldwide disease burden and are the most common reason for prescribing antibiotics. Many infections are viral and do not require or respond to antibiotics, but during COVID-19, concerns around bacterial co-infection in COVID-19 led to wider use of antibiotics.

The authors wrote that in some countries, antibiotics were prescribed for about 70% of patients with COVID-19, even though their use was only justified in about 1 in 10 of them.

Norwegian researchers retrospectively assessed the impact of antibiotic therapy on mortality in 2111 adults admitted to Akershus University Hospital with a nasopharyngeal or throat swab at hospital admittance that was positive for influenza virus, respiratory syncytial virus, or SARS-CoV-2 between 2017 and 2021.

Patients with a confirmed bacterial pathogen and patients with other infections requiring antibiotic therapy were excluded. Antibiotic therapy was initiated in over half (55%; 1153/2111) of patients with viral respiratory infections at admission to the hospital. During hospitalization, an additional 168 patients were given antibiotics, making the total percentage of patients receiving antibiotics 63%.

Overall, 168 (8%) patients died within 30 days—119 patients prescribed antibiotics at admission, 27 patients given antibiotics later during their hospital stay, and 22 patients not prescribed antibiotics.

After adjusting for virus type, sex, age, severity of disease, and underlying illnesses, the analysis found that patients prescribed antibiotics at any time during their hospital stay (including at admission) were twice as likely to die within 30 days than those not given antibiotics.

Moreover, the risk of mortality increased by 3% for each day of antibiotic therapy compared with those not given antibiotics.

However, starting antibiotics at hospital admission was not associated with an increased risk of death within 30 days.

“Lessons from the COVID-19 pandemic suggest that antibiotics can safely be withheld in most patients with viral respiratory infections, and that fear of bacterial co-infections may be exaggerated,” says lead author Magrit Jarlsdatter Hovind , MD, from Akershus University Hospital and the University of Oslo, Norway, in a statement. “Our new study adds to this evidence, suggesting that giving antibiotics to people hospitalized with common respiratory infections is unlikely to lower the risk of death within 30 days. Such a high degree of potentially unnecessary prescribing has important implications given the growing threat of antimicrobial resistance.”

She said it is possible that "sicker patients and those with more underlying illnesses were both more likely to get antibiotics and to die."

The study had several limitations. It was an observational design, and data were not available for certain biochemistry/biomarkers such as white blood cell counts, C-reactive protein, and creatinine. In addition, there may have been other factors that were unreported, such as smoking and socioeconomic background, that may have influenced outcomes.

Prospective randomized trials are needed to confirm the results, the researchers noted.


Hovind MJ, Berdal JE, Dalgard O, Lyngbakken MN. A retrospective study on impact of antibiotic therapy on mortality in viral respiratory infections. European Congress of Clinical Microbiology & Infectious Diseases; April 15-18, 2023. Copenhagen, Norway. Oral presentation.

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