Extenuating Clinical Circumstances and the Possible Use of
Clarithromycin:
It is well recognized that there may be extenuating clinical
circumstances where clinicians decide to use unproven therapies when
clinical trials are unavailable. In those circumstances where unproven
therapies are used, the WHO has provided a standardized case report form
for data collection to ensure that there is a contribution to scientific
research and the clinical community (88).
As with any viral pneumonia, COVID-19 itself up to here has not been an
indication for antibiotics. However, patients who present with
respiratory symptoms and pulmonary infiltrates on imaging may meet the
diagnostic criteria for COVID-19 and Bacterial Pneumonia or just
Bacterial Pneumonia without COVID-19 when the diagnostic tests are done
and the results are obtained (100). Typical or Atypical pulmonary
Infection without COVID-19 or COVID-19 with pulmonary co-infection with
any bacterial pathogen can be possible, and as per standard therapy,
antibiotics should be indicated in both situations. Losing time until
the initial antibiotic treatment or non-response to initial
antimicrobial therapy will increase mortality in both situations. Then,
the initial and urgent selection of antimicrobials is critical.
According
to NICE
(89), to cover atypical and multiple pathogens in older patients with
pneumonia and at risk of severe complications, the recommended choices
of antibiotics in the community are: