In 2017, Professor Dame Sally Davies, England’s Chief Medical Officer at the time, warned that the world could face a “post-antibiotic apocalypse.” She urged that, unless action is taken to halt the practices that have allowed antibiotic resistance to spread and ways are found to develop new types of antibiotics, we could return to the days when simple wounds, infections or routine operations, are life-threatening.
We created this page in 2017 to mark World Antibiotic Awareness Week and we keep it up-to-date. In 2021, the threat of antibiotic resistance – and the need for responsible antibiotic use – are as great as ever.
Below, you can find summaries of Cochrane Reviews which have investigated the benefits and harms of antibiotics for a wide range of health problems. This evidence supports decision-making in the appropriate use of antibiotics.
Page last updated 09 November 2021.
Respiratory infections, illnesses and conditions
Are antibiotics an effective treatment for COVID-19 and do they cause unwanted effects?
Recently, antibiotics have been studied as a potential treatment for COVID-19. This is because some laboratory studies have suggested that some antibiotics slow the reproduction of certain viruses, including SARS-CoV-2, the virus that causes COVID-19. There has been particular interest in one antibiotic, azithromycin, as some laboratory studies have indicated it may reduce inflammation and viral activity. However, we need good evidence before using antibiotics for COVID-19. This is because overuse and/or misuse of antibiotics can lead to ‘antimicrobial resistance’ where, ultimately, antibiotics stop working.
The authors of the review Antibiotics for the treatment of COVID‐19 (published October 2021) found 11 studies with 11,281 people. The studies only investigated one antibiotic, azithromycin, so we do not know the effects of other antibiotics for treating COVID-19.
Only nine of the studies reported data that could be analysed. These studies (with 10,807 people) compared azithromycin to no treatment, placebo or usual care alone.
For inpatients with moderate-to-severe COVID-19:
- Azithromycin does not lead to more or fewer deaths in the 28 days after treatment
- Azithromycin probably does not:
- worsen or improve patients’ condition
- increase or decrease serious unwanted events, or heart rhythm problems
- Azithromycin may increase non-serious unwanted effects slightly
No studies looked at quality of life.
People with mild COVID-19:
For people with mild COVID-19 (or with no symptoms), treated as outpatients, azithromycin may have little to no benefit. The evidence about possible serious unwanted effects is uncertain. No studies reported on non-serious unwanted events, heart rhythm problems, or quality of life.
The review authors found 19 ongoing studies that are investigating antibiotics for COVID-19 and will update this review soon.
However, given the current evidence and the threat of antimicrobial resistance, the authors say that “antibiotics should not be used for treatment of COVID-19 outside well-designed randomized controlled trials”.
Deciding when to start and stop antibiotics in adults with acute respiratory infections: can testing blood procalcitonin levels help?
In children aged 2-59 months with severe pneumonia, what are the benefits and harms of a short course of intravenous antibiotics compared with a long course?
Which antibiotic regimen is safer and more effective in treating neonates (newborns) and children with hospital‐acquired pneumonia?
What are the benefits and harms of antibiotics for treating cough or wheeze after acute bronchiolitis in children?
In patients with bronchiectasis, how do continuous antibiotics compare with intermittent antibiotics?
Labour and birth
What are the benefits and harms of prophylactic antibiotics for women undergoing operative vaginal delivery?
What are the benefits and harms of routine antibiotic prophylaxis after normal (uncomplicated) vaginal birth?
What are the benefits and harms of routine antibiotics for women undergoing episiotomy repair after a normal (uncomplicated) vaginal birth?
What are the benefits are harms of antibiotics for irreversible pulpitis (severe tissue damage within a tooth, which causes severe tooth ache)?
What are the benefits and harms of giving antibiotics prior to admission to hospital for suspected meningococcal disease?
In women undergoing a cervical excision to reduce the risk of developing cervical cancer, what are the benefits and harms of antibiotics?
Can antibiotics given around the time of transplant surgery prevent surgical site infections in organ transplant recipients?
What are the benefits and harms of antibiotics in kidney transplant recipients who have bacterial infection in the urine but no symptoms?
Prescribing practices and choosing appropriate antibiotic treatment
Can rapid point‐of‐care tests help reduce antibiotic use in people with acute sore throat in primary care?
- Antibiotic resistance – bacteria fighting back by Samantha Gale, Cochrane UK’s Public Health Fellow.
- Apocalypse now – antimicrobial resistance by Lynda Ware, Cochrane UK’s Senior Fellow in General Practice.
- Why should I care about antibiotic resistance? by the Cochrane Trainees.
- More blogs about antibiotics on Evidently Cochrane.