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: