Here we aim to answer your questions regarding COVID-19, antibiotics and antibiotic resistant infections. If you have a question you'd like answered, you can use the form to ask our patient support team and we will answer it within 48 hours depending on the question's complexity.
I heard the other day that one of my friends had a C. diff infection. What is C. diff and is it dangerous?
C. diff or Clostridium difficile is a bacterium commonly found in the gut. Often when people are given antibiotics for an infection, most of the gut bacteria are killed except for C. diff which can grow in the gut to give rise to symptoms such as diarrhoea and sickness. Those most at risk are the elderly and those in poorer health. C. diff infection is normally treated with antibiotics such as vancomycin. Most people will recover with treatment but in extreme cases a C. diff infection can lead to hospitalisation and death (https://www.meht.nhs.uk/patients-and-visitors/infection-prevention/about-c-diff/).
It is important to follow these measures to alleviate any ongoing symptoms: make sure you finish the antibiotics prescribed for the C. diff; wash your hands with soap and water regularly and after you have been to the toilet; drink plenty of fluids to avoid symptoms of dehydration; do not take any anti-diarrhoea medication; wash surfaces and bedding regularly; do not share towels with anyone; stay at home for 48 hours after your symptoms have cleared up. You can find further information here: https://www.nhs.uk/conditions/c-difficile/
There are two flu vaccines available: one has four different viruses in it (the quadrivalent one) and one with three different viral strains (the trivalent one). The trivalent one also includes an additional ingredient (called the adjuvant) which helps boost the recipient’s immune response.
Therefore, older people over 65 who tend not to give such a strong immune response compared to younger people should have the trivalent vaccine.
Although you might think the quadrivalent one is the ‘better’ one, one of the four viruses it contains does not normally make older people ill, only younger people. It is therefore better for younger people to have the quadrivalent vaccine and older people to have the trivalent one with the adjuvant that helps the immune system work better. The ideal might be for everyone to get a quadrivalent one with adjuvant but that is not available. The pharmacist – or other clinic – will check your age and give you the right one.
UK poultry meat producers have stopped all antibiotic preventative treatments and the highest priority antibiotics that are critically important for humans are used only as a ‘last resort’ for chickens and turkeys. Between 2012 – 2019 there has been a 76% reduction in the use of antibiotics in the poultry industry. If you are concerned about antibiotics being used in the poultry industry why not ask your supplier the question have antibiotics been used in the rearing of my turkey?
Uncooked meat including turkey can be contaminated with bacteria such as Salmonella that can cause food poisoning. Here are some tips to avoid your Christmas break being spoiled:
1) don’t wash your turkey – contaminated splashes from the carcass might get on your hands and into your mouth
2) make sure you wash your hands, all containers, chopping boards and knives if they have been in contact with your raw turkey
3) make sure your turkey is cooked all the way through preferably by testing with a meat thermometer
4) if you have leftover turkey, keep it in the fridge after it has cooled down from the oven
5) if you freeze your turkey leftovers make sure they are thoroughly defrosted before reheating or to be used in a recipe
Probiotics and live culture yoghurts have often been promoted in preventing antibiotic-induced diarrhoea. However, the research data is conflicting. Some studies have suggested that using these products does treat the diarrhoea but equally others have not. The evidence that they can prevent diarrhoea when taken during a course of antibiotics is a little more convincing but still not conclusive. The jury is still out on this question!
Clostridium difficile (C. Diff) is a bacterial infection which causes up to 30% of antibiotic-associated diarrhoea with a wide spectrum of severity from a mild to life-threatening illness.
A fifth of cases are cured within 3 days by stopping the antibiotic. More severe cases will need specific antibiotic therapy and some will need repeat treatment.
It is highly infectious, especially in hospital and care-home settings. The elderly and those with significant underlying disease are most vulnerable. In these situations, strict basic hygiene practice often prevents the spread of infection between individuals.
Careful and effective use of antibiotics greatly diminishes the risk of this infection. Conversely, taking broad spectrum or combination antibiotics, prolonged and/or repeated antibiotic courses increase the risk of C. Diff. The use of acid suppressing therapy at the same time as antibiotics also increases the risk of acquiring C. Diff infection.
Yes, it occurs in up to a quarter of people on treatment and is more common with some types of antibiotic, particularly broad-spectrum ones. It is due to an alteration in the balance of different bacteria in the gut.
Most cases are mild and self-limiting, stopping within a few days of finishing the treatment course, but sometimes you will need to stop the antibiotics and seek your GP’s advice. Make sure you drink plenty of fluids while you have symptoms. About 20-30% of cases are caused by Clostridium difficile infection which can be more serious.
Toothache is often caused by inflammation rather than infection. Analgesics such as paracetamol and ibuprofen treat inflammatory pain – antibiotics do not fix inflammation.
Even if you have a bacterial infection associated with a dead tooth (a dental abscess), antibiotics are not usually the right answer. Antibiotics cannot easily get inside the tooth to the root of the infection. The quickest fix is usually to remove the source of the infection using a dental procedure – there are various ways to do this which you should ask your dentist about. Even when antibiotics are required for a severe infection, they should be used along with a dental procedure. Taking antibiotics when they are not necessary increases the chance that they will not work for an infection (such as sepsis or pneumonia) when you really do need to them to work.
When you have toothache, visit your dentist who can diagnose the cause and offer you appropriate options for treatment. Doctors in GP practices or A&E are not able to diagnose toothache and you are likely to be in pain for longer than if you see a dentist. If you don’t have your own dentist, call NHS111 and they will be able to help you find someone who can provide the care you need.
Sometimes my dog has had to have antibiotics. This made me wonder whether my family could also get any antimicrobial resistance from my dog or vice versa?
Antibiotic resistance can affect the health of both people and animals. In fact, many microbes (germs) do not recognise these types of boundaries, and the same bacteria, virus and fungi can be found in different types of animals, and humans. This includes our pets, such as dogs who can also get bacterial illness, sometimes requiring treatment with antibiotics. Veterinarians are becoming more focused on their use of antibiotics and significant improvements have been made by vets to reduce inappropriate use of antibiotics to decrease the risk of antimicrobial resistance in the future.
Antibiotic resistant bacteria that transfer from an animal to a human, is called ‘zoonotic’ – this just means it can adapt and survive on animals and humans. Therefore, it is possible for you to get a bacterial infection from one of your pets that is resistant to antibiotics. This doesn’t mean stop loving and caring for your pets – but it does mean that you need to take some additional basic hygiene precautions, including hand washing after touching the dog, and avoiding close contact when you are eating to reduce the risk of resistant bacteria passing from your dog and into your gut. Talk to your veterinarian if you are concerned.
Under no circumstances must you ever use medication intended for your dog, or vice versa. Even though the same types (classes) of antibiotics are commonly used on humans and animals, the doses, strength and duration will usually differ markedly.
I had a stem cell transplant as part of my cancer treatment. I was told I have ‘a new immune system’. What does this mean – will I always be more prone to infection?
Following a stem cell transplant you will have very low white blood cells (these are the blood cells that help fight infection and make up your immune system within the blood stream). This is due to the treatment you have had. When doctors or nurses say ‘new immune system’ they mean that your immune system needs to build up again i.e. building up the white blood cells within the blood stream to help fight infection. The time it takes can vary from person to person, but they may remain low for some time. Unfortunately, this means you may be more prone to getting infections. These infections/bacteria would usually cause no problem and are usually harmless to people with normal immune systems.
I was told in hospital that I carry MRSA, but wasn’t given any further information. How did I get it and what does it mean for the future?
Methicillin Resistant Staphylococcus Aureus (MRSA) is a type of staphylococcus aureus bacteria that is resistant to many antibiotics. When resistant they can still live on your skin and up your nose and cause no problems or symptoms; this is called colonisation and can happen through:
• touching the skin of a person who is colonised with MRSA
• touching a contaminated surface like a door handle, phone or work surface.
If your skin is colonised and you have an opening in your skin (when the barrier is breached) the bacteria are opportunistic and can enter the opening thus causing an infection. MRSA can also enter the bloodstream through medical procedures and devices like surgical incisions (cut to skin) or medical devices like a cannula (intravenous drip).
If you are found to be colonised with the bacteria, the doctor may prescribe skin washing with special soap for your body and/or cream for your nose. This treatment is called decolonisation.
If you have symptoms of the infection your doctor may prescribe antibiotics to treat it. If you have been told you have a collection of pus anywhere (like an abscess) the doctors may want to drain it (take the fluid out) or operate to remove it. Some infections can’t be treated with oral antibiotics (tablets or capsules) and need to be treated with intravenous antibiotics.
You can read Tony’s story about living with MRSA here.
We are drying wet laundry within an enclosed open plan living area without ventilation (eg. no windows open in the winter) but should we be worried about the build up of bacteria?
Condensation remains arguably the largest cause of dampness in indoor areas, and can eventually lead to the growth of mould. If left unaddressed, condensation can also damage property by fraying curtains, peeling wallpaper and creating a generally musty environment.
The growth of fungi like mould, is probably a greater risk to the health of those living there than bacteria build up. There are some things you can do to try to reduce the risk of bacteria or fungal spores forming. They include dehumidifiers, electric clothing racks for fast warm drying of clothes – but of course, involve investment. You can find ideas here.
The NHS website contains useful information about reducing the risk of germs spreading in all sorts of places.
It includes helpful information on laundering clothes too, such as:
Wash your hands after handling dirty laundry;
All underwear, towels, and household linens should be washed at 60C (140F) with a bleach-based laundry product to prevent germs from spreading;
Don’t leave laundry in the washing machine – any remaining germs can multiply rapidly.
The use of antibiotics has long been linked to deprivation of gut bacteria, which are needed to help build up the immune system. One study shows that the makeup and function of gut bacteria can mostly recover after antibiotic treatment in healthy people. So essentially that means we are able to regenerate our gut bacteria and environment which is important for our general health. The concern, however, relates to potentially losing some of those beneficial bacteria permanently after multiple courses of antibiotics during our lifetime. We should therefore aim to minimise the number of antibiotic courses we take wherever possible, by only taking antibiotics when absolutely necessary.
Vaccines are used for protection against potential future infection and designed to induce a protective immune response in your body. The specific, protective immune cells have a memory element to protect for any future infection by that particular virus. These memory cells allow for a quick response so that when exposed to that virus, you are quickly protected and can avoid becoming ill.
Antibiotics are effective for eradicating bacteria but do not have any effect on viruses. Antibiotics are used when there is a current bacterial infection present. Inappropriate use of antibiotics is a growing concern globally now, with some bacteria developing antibiotic-resistant strains, like Methicillin-resistant Staphylococcus aureus (MRSA) , ESBL E Coli or Carbapenem Resistant Enterobacteriaceae (CRE), resulting in certain antibiotics becoming ineffective. You can read more about drug-resistant bacteria here and how Antibiotic Research UK is tackling this problem.
Blood poisoning or septicaemia are both terms which refer to the invasion of bacteria into the bloodstream causing severe infection. Sepsis is a more rare, but serious complication of infection. It can lead to multiple organ failure and even death, sometimes without blood poisoning or septicaemia. The main cause of sepsis is usually bacterial infection, although sepsis can sometimes be due to fungal or viral infection ( like COVID-19). You can find out more about sepsis here.
When someone gets infected with any general flu type virus, the virus can hijack the person’s immune system. As a consequence, that person is then susceptible to getting what is called a secondary bacterial infection. It is estimated that in general between 10 – 30% of patients with a flu type virus will get a secondary bacterial infection. It is becoming increasingly clear that people who are weakened by COVID-19 are susceptible to contracting secondary bacterial infections. These can be acquired in hospital and are often resistant to treatment with antibiotics. You can explore the facts and figures published so far HERE.
I need to have a shingles vaccine, how long should I wait before having this and the COVID-19 vaccine?
The manufacturers’ information for the Pfizer/BioNTech, AstraZeneca and Moderna COVID-19 vaccines is as follows:
“It should not be routine to offer appointments to give this vaccine at the same time as other vaccines. Scheduling should ideally be separated by an interval of at least 7 days to avoid the potential of adverse events.”
Therefore at least 7 days should be allowed between having the shingles vaccine and the COVID-19 vaccine.
I have rheumatoid arthritis and I routinely have steroids. Is it safe for me to have the COVID-19 vaccine?
The British Society of Rheumatology have given this advice from Arthritis and Musculoskeletal Alliance (ARMA)
“There are some general principles but in each case the benefits and risks should be discussed with the patient to arrive at a shared decision”.
It is safe to have the COVID-19 vaccine alongside steroids, but the patient may not have such a good immune response. The vaccine should not be delayed for someone who is taking, has received or is soon to receive steroids in any form. It may be appropriate to delay a non-essential steroid injection, as part of a shared decision, so that the response to the vaccine is more effective. In this scenario, the steroid injection should be delayed by two weeks after the vaccine, to enable the patient to get the best response to the COVID-19 vaccine.
The vaccine is intended to stop you getting COVID-19 infection, which should then reduce the likelihood of you spreading the infection by becoming ill. Since the vaccine is still relatively new, it is not yet known if vaccination prevents the virus being carried in the nose and throat of people who have been vaccinated. As the vaccination programme is rolled out more widely, the impact of vaccination on the spread of the virus spread will be better understood. The best way to avoid catching or spreading the virus is to have the vaccination when invited to, and keep following measures to reduce spread like social distancing, hand and respiratory hygiene and face coverings where advised.
It is important to have both doses of the vaccine to give you the best protection. The first dose of the COVID-19 vaccine should provide high short-term protection against severe disease for a duration of around 12 weeks while the second dose gives a more durable and longer protection against COVID-19. It can be assumed that protection from the first dose will wane in the medium term, and the second dose will still be required to provide more longer lasting protection.
You need both doses to give you the best cover and protection from COVID-19. The first injection prompts your body to begin producing an immune response, whereas the second dose helps your body to boost its immune response to the virus. You need both doses for best protection. It is also important to give your body enough time to build this immune response, so protection is not immediate. It can take a week or two for your body to produce that immune response, and so you should still follow the advice around social distancing and hand hygiene etc.
Knowledge about COVID-19 is still growing and we don’t yet know if having infection with COVID-19 means you’ll have long-term immunity particularly to variants. So you should still attend for your vaccination even if you have previously tested positive for COVID-19 or for COVID-19 antibodies. However, you should postpone your COVID-19 vaccine for four weeks from symptoms of COVID-19 starting, or from testing positive for COVID-19 even without symptoms.
I am due my COVID-19 vaccine this week. Can I still have it if someone is self-isolating in my household?
You should go ahead with the vaccine, provided you or the person self-isolating has no COVID-19 symptoms or had a positive test. There are only a few instances where someone should not proceed to be vaccinated, such as a high temperature, or febrile illness. However, if the person self-isolating in your household develops symptoms of COVID-19 or tests positive, then this would change the position. You would then need to self-isolate too, for the required length of time and postpone your vaccination. The vaccination centre would not wish to vaccinate anyone with possible symptoms of COVID-19 or to risk spreading the virus within the vaccination centre. The vaccine takes a few weeks for your body to build an immune response so it does not provide immediate protection.
It is still too early to say if the current vaccines will work on the different COVID variants. The Kent variant (B.1.1.7) is now the main virus being identified in the UK and is more transmissible than the original UK virus found in February 2020. It appears that the Oxford / AstraZeneca and Pfizer / BioNtech vaccines are effective in boosting immunity against the Kent variant. We will update as new information becomes available.
I hear the terms mutant and variant used a lot in the media about the COVID virus. What does it mean?
For viruses, the term mutant means that the RNA sequence (genetic message for the virus) has undergone a change (mutation). The resulting virus with the mutation is called a variant, eg. you will hear about Kent variant, South African variant, Brazilian variant. Each of these variants have different mutations. Mutations occur in every living organism including humans, viruses and bacteria (antibiotic resistance is caused by mutations).
There is usually no reason to avoid having your COVID-19 vaccine simply because you are taking antibiotics. However, where someone is experiencing current acute severe illness with fever, the information from manufacturers state that vaccinations should be postponed.
Public Health England’s Immunisation Against Infectious Disease (the Green Book) also states that minor illnesses without fever or systemic upset are not valid reasons to postpone immunisation. Individuals who are acutely unwell can have their immunisation postponed until they have fully recovered. This is to avoid confusing the differential diagnosis of any acute illness (including COVID-19) by wrongly attributing any signs or symptoms to the adverse effects of the vaccine.
COVID-19 vaccines trigger the body’s natural production of antibodies and stimulate immune cells to attack and neutralize the virus and hence protect against COVID-19 disease. This is why antibiotics will be unlikely to have an effect on the effectiveness of the vaccine to stimulate the immune system. Antibiotics are used to treat bacterial infections and have no effect on the virus or your immune response to the vaccine. You can read more about bacterial infections here:
You can discuss vaccine concerns with the health professional administering your vaccine.
If you wish to download and print a copy of this question and answer click HERE. If you are on antibiotics then show this advice to your vaccinator.
Here is detailed information about the vaccines.
Some countries are not approving the Oxford / AstraZeneca vaccine to be administered to the over 65s. I am over 65 and live in the UK. Should I be concerned?
The Oxford / AstraZeneca vaccine induces a strong immune response in the over 65s and is safe. The vaccine has been registered for use by the UK regulatory body, the MHRA as well as the central European regulator the EMA to be administered in anyone over the age of 18. A strong immune response indicates that the vaccine induces the production of antibodies that target the virus. It is not known currently if the other arm of the body’s immune system, memory T-cells are induced by the vaccine.
How effective are the Pfizer / BioNTech and AstraZeneca / Oxford COVID 19 vaccines likely to be with a longer period between the two doses, compared to those separated by 3 weeks?
Clinical trial data suggests that the Pfizer / BioNTech vaccine doses should be spaced out by 3 weeks i.e. dose one followed by dose two 3 weeks later. The AstraZeneca / Oxford vaccine has limited data suggesting that a longer period than 3 weeks between doses may be preferable.
No further trial information is available yet to give decisive answers on this.
Sadly there are very few vaccines for the treatment of bacterial infections and much more research is needed for this too.
The first indicator we will see is likely to be a reduction in the number of deaths in hospital from COVID-19. Current data suggest that around 75% of deaths from COVID-19 have been in the over 75 age group. You can read more here.
Assuming COVID vaccines are 70% effective on average then death rates should reduce by approximately 50%. This will hopefully be followed by a decrease in numbers of people requiring admission to hospital with this virus. Sadly there are very few vaccines for the treatment of bacterial infections and much more research is needed.
Ideally a 7-day gap should be left between vaccines so any adverse reactions or side-effects can be linked to the correct vaccine. However, NHS England says they have updated this advice so other vaccines (like flu) can now be given at the same time as COVID-19 vaccines especially if there is a danger of delay, reduced access or the person not returning for the other vaccine. This is particularly aimed at care-home residents, housebound patients, hard-to-reach or vulnerable groups.
It seems that a few people have natural immunity to COVID-19 because they mount a T-cell response, indicating they may previously have been exposed to another virus of the coronavirus family such as SARS or MERS. T-cells are white blood cells which work in several different ways to help protect us from diseases like COVID-19 and form a part of the body’s immune system. T-cells kill infectious agents including viruses and bacteria by sometimes attacking the infection directly or the infected human cells.
A T-cell response could also help to explain why some people recover relatively quickly from COVID-19, but others continue to suffer chronic after-effects for months following infection. You can read more about the role of T-cells here.
The main reason that this virus is so infectious is because humans have never been exposed to this particular virus before – it is completely new and they have no immunity. In other words, as the virus enters the human body, the body has no pre-existing defences since it doesn’t recognise the COVID-19 virus as a dangerous intruder.
Yes – it will be effective at helping prevent flu, and it’s safe to have the vaccination even if you’ve already had COVID-19.
No – flu (influenza) and COVID-19 are both contagious respiratory illnesses, but they are caused by completely different viruses. COVID-19 is caused by a new coronavirus called SARS-CoV-2, whereas the flu vaccine provides protection against three or four influenza viruses that are expected to be the most common during the forthcoming winter. However, it is worth having the flu vaccine if eligible, as it will reduce the risk of acquiring flu and developing complications which can arise ( such as pneumonia). It will also reduce the likelihood of suffering both viral infections at the same time which research shows can leave you more seriously ill.
Flu symptoms seems very similar to coronavirus. How can I tell if I have COVID-19 or just the flu?
It could be difficult to know if you have flu or COVID-19, based on symptoms alone as many are similar, eg. fever, headache, sore throat, fatigue, aches and pains. The most predominant symptoms in COVID-19 are fever, dry cough and new loss of taste and/or smell. If you have any of these symptoms or suspect you could have COVID-19 you should follow the advice to self-isolate, book a test, and stay in isolation until you get results. Then follow instructions if the COVID-19 test result is positive.
Flu (also known as influenza) tends to affect the whole body and can lead to complications such as pneumonia in vulnerable people. For this reason, many more flu vaccinations are being made available free through the NHS this year, to protect a greater number of people and especially those in more vulnerable groups. You can find more information about getting a flu vaccine here.
My daughter is on penicillin for tonsillitis. She has had a negative COVID-19 test result which is surprising because my son is positive for COVID-19 and she has all the COVID-19 symptoms. Is it possible that being on penicillin has produced a false negative result for COVID-19 when it should have been positive?
It is highly unlikely that the penicillin has interfered with the COVID-19 test as it only affects bacteria, not viruses. However, more information is being published about specificity and sensitivity of COVID-19 tests. That essentially measures how accurate the testing is – and recent information suggests that there can be reasonable incidence of False Negative tests occurring in those who actually have COVID-19. A BMJ article has reinforced a key message that “a single negative COVID-19 test should not be used as a rule-out in patients with strongly suggestive symptoms”. The more important action is to isolate and follow the usual guidance if you believe she (or anyone in the household) has COVID-19 symptoms.
I am taking antibiotics for a urinary tract infection. Is it OK to be tested for COVID-19 or will the antibiotics interfere with the test result?
T-cells are cells in the blood that provide a further way of attacking the virus. There are three ways viruses can be attacked two of which are through antibodies but the other is through T-cells. T-cells attack cells in the body that contain the virus or may even attack the virus directly. Memory T-cells are T-cells that have a memory of a previous infection and spring into action if the body encounters a virus from a previous infection. It may be that T-cells provide a long term way of fighting COVID-19 infections since it appears that the antibody response to the infection may be short-lived (weeks to months). T-cells on the other hand may be active for much longer. If COVID-19 vaccines are to be successful they need to produce not only an antibody response but also T-cell immunity.
Are there COVID-19 tests that can be done by everyone in their home to know 1) if they are infected with the virus and 2) if they have been infected with the virus?
Unlike for antibiotic resistant bacteria, home based tests are nearing general release to detect either the virus or antibodies to it. A number of tests are being evaluated to detect active viral infection using saliva rather than swab samples. Antibody detection tests to see if you have antibodies against the virus will also soon be available. These will require a pin prick of blood which is placed on the device and lets you know if you have antibodies. We do not yet know if you have antibodies that you will be immune to viral infection.
Yes. If your child shows any of the symptoms of coronavirus, you should still have them tested. Now that children are back to school in the UK, it’s important that you follow the guidance. If you have any of the main symptoms of coronavirus: get a test to check if your child has coronavirus as soon as possible. Keep them off school, stay at home and do not have visitors until you get their test result – only leave your home to have a test. Anyone you live with, and anyone in your support bubble, must also stay at home until they get their result.
There are 7 strains that can affect humans; 4 of these strains are the common human coronavirus that cause mild upper respiratory type symptoms – cold like symptoms. The 3 other coronaviruses cause more serious lower respiratory symptoms. They are known as MERS-CoV, SARS-CoV and SARS-COV 2 (COVID-19)
Mid-1960’s. There are seven strains that can affect humans. Four of these strains are the common human coronavirus that cause mild upper respiratory type symptoms – cold-like symptoms. The three other coronaviruses cause more serious lower respiratory symptoms. They are known as MERS-CoV, SARS-CoV and SARS-COV 2 (COVID-19).
Why do some well known brands of antibacterial sprays state that they are effective against Coronavirus? Did they know about Coronavirus before it happened?
There are various strains of Coronavirus, and they previously (and still do) caused symptoms of the common cold and these usually caused mild symptoms. Coronavirus has been around for a long time; COVID-19 is a new strain to affect humans.
If clinicians don’t know if a hospitalised COVID-19 patient has a secondary bacterial infection, how do they decide which empiric antibiotic to use for that patient?
In an ideal world they would want to know which bacteria a patient is infected with and give the most appropriate antibiotic known to treat that bacterial species. Without this information, clinicians are left with administering a broad-spectrum antibiotic in the hope that it will kill whatever bacteria are causing the infection. Broad-spectrum antibiotics are active against a wider number of bacterial types and, thus, may be used to treat a variety of infectious diseases, especially when the infecting agent (bacteria) is unknown. The antibiotic choice is usually guided on what symptoms and severity of illness the patient presents with. For example, If the patient has respiratory symptoms they would treat for a respiratory tract infection with antibiotics that are more targeted for that type of infection. Doctors monitor bloods, observations (BP, temp, respiratory rate, etc.) for improvement and take guidance from that.
Do we know what percentage of hospitalised COVID-19 patients develop a secondary bacterial infection?
There are very few reports which record the frequency of secondary bacterial infections such as bacterial pneumonia. In a large meta-analysis, (that’s where data from a number of studies is combined and analysed) numbers of around 7% were reported (details here). On the other hand, anecdotal evidence during the current COVID-19 pandemic from two English large city hospitals suggest a figure of around 20 – 30%. However, because of our inability to obtain this information in real time, we won’t ever know exact numbers of patients affected with a secondary bacterial infection.
I have heard that when COVID-19 patients are admitted to hospital, they are often given antibiotics empirically. Is this true?
Some patients with severe COVID-19 symptoms can develop sepsis very quickly. To try and prevent such patients going into septic shock, empiric antibiotics are given without knowing whether the patient has or has not got a bacterial respiratory infection. Until rapid bedside diagnostic tests are developed for determining if the patient has a bacterial infection and if so which organism, the clinician has no choice but to give empiric antibiotics (read more here)
Antibiotic prophylaxis is the use of antibiotics (usually) before surgery, to prevent a bacterial infection. Empiric antibiotic therapy is often given to patients who have a proven or suspected infection, but where the responsible organism(s) or bacteria have not yet been identified.
Current evidence does not suggest that having excess weight increases people’s chances of contracting COVID-19. However, a recent report from Public Health England confirms that you would be at more serious risk of severe illness or even death if you did contract COVID-19 and were excessively overweight or obese.
Being severely overweight puts people at greater risk of hospitalisation, being admitted to Intensive Care Units (ICUs) and death from COVID-19, with that risk rising as body mass index (BMI) increases. People are therefore being encouraged to move towards and maintain a healthier weight. You can read more here.
You can calculate your own BMI here.
No – thermal scanners are good at detecting fever i.e. those people who have a higher temperature than normal body temperature. Fever is one of the symptoms linked to COVID-19 – but there are many other possible causes of fever.
No – the WHO says you shouldn’t wear one when exercising as masks may reduce the ability to breathe comfortably. The mask could become wet more quickly as a result of sweat, which can make it difficult to breathe and could cause the growth of micro-organisms. Maintaining social distance from others during exercise is the most important preventative measure you can follow.
No – you will not get pleurisy, an inflammation of the tissue around the lung, by wearing a face mask for too long. There have been several other myths like this in circulation around masks and carbon dioxide and oxygen levels too. The WHO says that while the prolonged use of medical masks may be uncomfortable, it does not lead to breathing in too much of your own carbon dioxide, nor cause oxygen deficiency. However, you should not re-use disposable masks, and make sure you change it if it becomes damp.
The most important thing to know about coronavirus on surfaces is that they can easily be cleaned with common household disinfectants that will kill the virus. Studies have shown that the COVID-19 virus can survive for up to 72 hours on plastic and stainless steel, less than 4 hours on copper and less than 24 hours on cardboard. Always clean your hands with soap and hot water or alcohol-based hand sanitiser and avoid touching your face.
Scientists have attempted to answer this question by studying the transmission dynamics of other human coronaviruses and by analysing the effect of weather on COVID-19. Firm conclusions are not yet possible but initial studies suggest that coronavirus transmission is likely to be more frequent during the winter months.
Several dogs and cats (domestic cats and a tiger) in contact with infected humans have tested positive for COVID-19. In addition, ferrets appear to be susceptible to the infection. In experimental conditions, both cats and ferrets were able to transmit infection to other animals of the same species, but there is no evidence that these animals can transmit the disease to humans and play a role in spreading COVID-19. COVID-19 is mainly spread through droplets produced when an infected person coughs, sneezes, or speaks.
There is a lot in the media about pneumonia at present, especially in connection with the Coronavirus. Can I protect myself against pneumonia?
There are two main types of pneumonia: bacterial and viral. As COVID‑19 pneumonia is caused by a virus, antibiotics are ineffective to prevent or treat. However, pneumonia can arise due to a secondary bacterial infection, and antibiotics may be prescribed when serious and/or it is unclear whether the pneumonia is bacterial or viral in origin.
The pneumococcal vaccine offers some protection against what could turn out to be deadly pneumococcal infections. It is available to at-risk patients including babies, adults over 65 and those who have heart or kidney conditions. Unlike the flu vaccine, adults don’t have to have the jab every year and your GP will contact if they think you need one.
This will vary depending on the individual patient’s needs. In COVID-19 people are commonly transferred to intensive care due to low oxygen levels, requiring additional support to ensure enough oxygen is delivered to the body’s vital organs and tissues. In this situation patients may require intubation and mechanical ventilation. Sometimes other methods of assisting breathing are used such as non-invasive ventilation (NIV) or continuous positive airway pressure (CPAP). This doesn’t always need to be done in an ICU environment, it depends on how stable the patient is and how they respond to the treatment. Turning patients onto their front (known as ‘proning’) is also often used to improve oxygen levels. Sometimes patients may require support of other organs, such as the kidneys, or medications given intravenously if blood pressure is dangerously low. Other treatments include administration of adequate nutrition and fluid, sometimes administered via a tube that goes from the nose into the stomach (an NG tube) if they are unable to take in adequate nutrition orally.
All patients in intensive care are closely monitored by the doctors and nurses on the unit, so that they can respond quickly to their individual needs.
I’ve just been offered a cystoscopy for next week. I’ve said yes but I’m absolutely terrified of going into hospital due to the coronavirus and my husband being high risk and myself and my son are asthmatic. What should I do?
Where treatments and procedures are essential, hospitals are ensuring that these patients are treated in areas well away from COVID-19 patients, and extensive hygiene and infection control practices are applied (see your hospital website or call the admissions office for more information). Since you and your family members are all considered to be at higher risk than the general population, you may wish to discuss with your GP the benefits of going ahead with the cystoscopy and measure that against the potential risks to you and your family. This is a difficult but very important decision you have to make, and you should be guided by your healthcare team in reaching that. You can read more about ‘shielding’ HERE, and the advice that has been given about protecting yourself from catching COVID-19 during this time.
A ‘cytokine storm’ refers to the overproduction of inflammatory proteins. These inflammatory proteins are an important part of the immune response (the body’s response to infection). However, in a cytokine storm the overproduction of these proteins are harmful. Sepsis is defined as life threatening organ dysfunction caused by a dysregulated host response to infection. When we hear sepsis being talked about in the news, this is often referring to bacterial infection as the cause of sepsis. However, the cytokine storm that we see in COVID-19 can be thought of as a type of viral sepsis. In addition, it is possible that secondary bacterial infections may develop when the body’s immune system is weakened from fighting the viral infection.
Like any other surface that large numbers of people come into contact with, notes can carry bacteria or viruses. However, the risk posed by handling a polymer note is no greater than touching any other common surface, such as handrails, doorknobs or credit cards. It is therefore important to think about all other money related surfaces you come into contact with which may have the virus on them and follow the same hygiene procedure such as sanitising hand wipes and hand washing after handling any money.
Sepsis is a life-threatening reaction to an infection. It happens when your immune system overreacts to an infection and starts to damage your body’s own tissues and organs. The overreactive immune response causing Sepsis can be triggered by any infection, bacterial or viral.
Although the majority of COVID-19 patients experience mild symptoms, some patients are admitted to hospital because they have a more serious illness which may include breathing difficulties. As there is no treatment for COVID-19 they are given supportive care which aims to maintain the function of the body’s vital organs to keep the individual alive while the disease progresses and eventually resolves. This involves providing the patient with supplementary oxygen via nasal tubes or face masks or in the sickest patients using a mechanical ventilator in ICU. Complications such as hospital-acquired bacterial infections of the chest, urine or bloodstream are common during treatment in ICU, which further increase the chance of the patient dying.
As COVID-19 is a new disease we still do not know the long-term effects. There is active research into this area but the results will not be available for some time. We know from experience with other diseases that people with critical illness requiring a long term stay in intensive care can experience long term consequences, such as psychological effects including anxiety, depression and post traumatic stress disorder. There may also be long-term effects on organ function such as kidney and lung function; and muscle wasting and weakness. It is important to note, however, that not everyone requiring intensive care admission will experience these long term consequences.
The virus test detects active infection and works best during the first seven days of symptoms. The coronavirus can be detected in swabs taken from the nose or throat, even before symptoms of illness first appear. This is why people can be infectious for a few days before the onset of symptoms, which usually appear about 5 days after the virus infects. Some people have no symptoms throughout their infection but are positive on the virus test and infectious to others. After a few days of illness the concentration of the virus falls (as seen in swab samples) and the symptoms of the illness usually recede, while the level of antibodies in the blood goes up.
I’ve read that they are trying to see if repurposed drugs can treat COVID-19 patients. What are repurposed drugs?
A repurposed drug is a drug developed for treating one disease but used to treat another. For example a drug being developed to treat diabetes was found to kill drug resistant bacteria. The hope with COVID-19 is that an existing drug can kill the virus and therefore be used to treat infected patients. There are approximately 1500 drugs in total – our charity has screened all these and found 10 drugs worth investigating further (see article here). Using existing drugs or combinations means that clinical studies can be undertaken quickly.
My family member was prescribed an antibiotic (Co-amoxiclav) while they had COVID-19, but I didn’t think antibiotics worked against a virus?
Co-amoxiclav is an antibiotic. Antibiotics do not treat any viruses including Coronavirus, but they are absolutely essential for treating bacterial infections. Patients with COVID-19 are very susceptible to secondary bacterial infections which can only be treated with antibiotics. It may be that your family member had developed a secondary bacterial infection.
There is a current trial investigating the impact of vitamin C in critically ill patients with COVID-19 in China, however we will not have the results of this for a number of months. There is currently not enough evidence to recommend vitamin C as standard treatment or prevention of COVID-19.
Some companies are selling home based antibody test kits but the UK health authorities have cautioned against people buying and using these kits (more info here).
You cannot be sure the results you receive are accurate and reliable. So current advice is do not buy home test kits until there are test kits which are validated and certificated by the UK government. Sadly, rapid diagnostic test kits for antibiotic resistant bacterial infections are not available either for home or hospital use. This is an area that also needs focus and investment to improve patient care.
You can read more about test kits here.
The COVID-19 swab test is used to detect if you currently HAVE the virus by taking a swab sample from your mouth (and sometimes your nose too), then it’s sent off to a specialist lab. These samples can also be taken at home but all samples must be sent to a government approved lab for analysis to ensure results are accurate and reliable.
An antibody test is a different type of test which looks for the presence of antibodies produced by the body when someone contracts COVID-19. This test can tell if a person HAS previously been infected at some point.
You can read more about tests here.
People from the Black Asian and Minority Ethnic (BAME) community seem to be more at risk of severe illness and death than white social groups. This may be due to greater exposure to COVID-19 in the type of work they do or living situation, or it may be linked to underlying health conditions such as heart disease or diabetes. Currently the increased risk has not been fully explained and the reasons are under investigation in further research studies. You can read more on the topic here.
Will COVID-19 affect those with Chronic Obstructive Pulmonary Disease (COPD) and heart failure more?
There is no specific treatment for COVID-19 (the disease caused by the Coronavirus) other than rest, fluids and paracetamol to treat the fever. Antibiotics do not work or protect you from viruses so you should ensure you have some paracetamol which works better than ibuprofen; keep warm and take lots of fluids and watch for any deterioration like breathing difficulties. See the NHS websites for emergency numbers and information.
Now that the children are back at school, I am worried about them getting COVID-19. I have heard that COVID-19 is less of a problem for children – is this true?
The NHS says that “Children can get coronavirus (COVID-19), but they seem to get it less often than adults and it’s usually less serious.” However, like any other group in society, they can spread the virus, even if they are not displaying obvious symptoms. Schools should be following the Government’s “Coronavirus (COVID-19): guidance for schools and other educational settings” guidelines, which cover safe-distancing and managing the dangers of transmission. If your child exhibits any of the symptoms of COVID-19, please visit here for help and advice.
One of the best things you can do is to support your immune system and strengthen it. The NHS advice includes trying to eat well, hydrate properly, take regular exercise and get enough rest and sleep. If you are worried that you are more vulnerable it is worth speaking to your GP and consider self isolating to shield you from the risk of catching the virus. Anyone who is immuno-suppressed is considered to be at more risk from COVID-19, however these are usually people treated with drugs which suppress the immune system. Antibiotics are not in this category.
Hydroxychloroquine or chloroquine, sometimes in combination with an antibiotic called azithromycin, has been widely discussed and used recently for treatment of COVID-19. While used and licensed for malaria and autoimmune diseases such as lupus, the safety and benefit of these medicines has not been proven in patients with COVID-19. Hydroxychloroquine was being tested as part of a large global study coordinated by the World Health Organization looking at a number of different drugs and their effect in COVID-19 patients. The hydroxychloroquine element of the study was put ‘on hold’ in May 2020 after the Lancet medical journal published a study of coronavirus patients in 671 hospitals across six continents that found those who took this drug were more likely to die or develop irregular heart rhythms than those who didn’t. The RECOVERY trial in the UK has also now closed testing of hydroxychloroquine for use in COVID-19 stating that “preliminary results from the RECOVERY trial are quite clear – hydroxychloroquine does not reduce the risk of death among hospitalised patients with this new disease”.
On 29 June 2020, the MHRA approved recruitment of further participants for a clinical trial investigating hydroxychloroquine in the prevention of COVID-19, by the University of Oxford.
Update: On 17 June 2020, WHO announced that the hydroxychloroquine (HCQ) arm of the Solidarity Trial to find an effective COVID-19 treatment was being stopped.
I have read a lot of conflicting things about antibiotics curing COVID-19. Is there any truth in that? Should I ask the doctor for some if I get symptoms? The news is very confusing on the matter!
Antibiotics do not treat viruses such as COVID-19, but they are absolutely essential for treating bacterial infections. Patients with COVID-19 are very susceptible to secondary bacterial infections which can only be treated with antibiotics. People on ventilators are particularly susceptible. We understand just how difficult it can be to find information on the internet which is trustworthy and reliable. You can find help HERE to work out what sources of information you can trust during these difficult times of information overload.
There are a number of existing antiviral drugs under investigation through clinical trials for use against COVID-19. Most of these drugs are already used for other viral conditions such as Ebola or HIV and some strains of seasonal flu, and none are yet clinically proven against COVID-19. Remdesivir is an antiviral under investigation against COVID-19 which has now been approved for clinical use in the UK for specific hospitalised patients. It is important to note that an opportunistic or secondary bacterial infection can develop in patients with COVID-19. This means we also need governments, globally, to ensure we are also focussing on developing new antibiotic treatments to reduce poor outcomes from the secondary bacterial infections and not just the virus itself.
Vitamin D helps to keep bones, teeth and muscles healthy. It also plays an important role in the immune system, which helps our body fight infection. However, the role that vitamin D plays in the management of COVID-19 is not completely clear currently. Clinical studies are ongoing to determine if vitamin D helps prevent respiratory complications, or whether it provides specific protection towards COVID-19. The emerging evidence suggests that the outcomes for those who develop COVID-19, and who already have a deficiency or insufficient levels of vitamin D, may be negatively affected in terms of morbidity (degree of ill health) and mortality (death rates).
The NHS across the UK advises anyone staying at home for most of the day, with limited exposure to sunlight, to consider taking a daily 10 microgram vitamin D supplement.
Links to further advice below:
The WHO guidance has not changed on this. The advice on this currently comes from the UK government.
Currently there is limited evidence for the use of masks (medical or other) for healthy individuals in the wider community. The WHO is actively studying the rapidly evolving science on masks and continuously updates its guidance. However, they stress that masks are not a replacement for good hand hygiene and social distancing practices. In June 2020, WHO issued new guidance to recommend that all people wear three layer face coverings in enclosed spaces such as public transport and shops where social distancing is not possible to attempt to reduce transmission of COVID-19. They also recommend that people over 60 or with underlying health conditions should wear medical grade masks where physical distancing is difficult to give themselves better protection. The governments within devolved countries are also issuing additional guidance and requirements on face coverings and masks which you can find on NHS information sites eg www.gov.uk.
If you have tested positive for coronavirus (COVID-19), you will probably have developed some immunity to the disease. But it cannot be guaranteed that will happen in all cases, nor exactly for how long that will last. There has been one report of a possible re-infection reported.
If you have previously tested positive but develop symptoms again, you must self-isolate for at least 7 days from onset of symptoms and be tested. If you live in a household, all other household members must stay at home for 14 days.
There is currently no evidence that people who have recovered from COVID-19 and have antibodies are protected from a second infection according to the WHO. However medical and scientific advisors to the government have suggested that based on the anti-body response to other viral infections including coronaviruses, it is unlikely that a person would be infected for a second time. However, The virus causing COVID-19 is so new that this needs to be further validated with evidence.
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We’re the only charity with a dedicated Patient Support service for people with antibiotic-resistant infections.