Geneva, August 7, 2025 — The World Health Organization (WHO) has issued strong updated clinical recommendations: do not prescribe antibiotics to COVID-19 patients — whether severe or mild — unless there is clear suspicion of a bacterial co-infection. This marks a critical shift in global clinical management to curb antibiotic overuse and slow antimicrobial resistance.
The revised guidance stems from a recent meta-analysis that revealed antibiotics offered no proven benefit for COVID-19 without a bacterial infection. In fact, they likely contributed to rising harms. Thus, WHO now recommends against empirical antibiotic use in non-severe COVID-19 where bacterial infection is unlikely. It further suggests avoiding antibiotics even in severe cases if bacterial risk remains low.
Why the Shift Matters
During the early pandemic, antibiotics were widely prescribed—often “just in case.” However, studies revealed only 8% of hospitalized COVID-19 patients had a bacterial co-infection, while antibiotic prescriptions soared to around 75%, especially in severe cases. Excessive use of broad-spectrum “Watch” group antibiotics intensified global antimicrobial resistance (AMR). Moreover, a large international cohort study reported that administering antibiotics to non-severe COVID-19 patients increased risk of clinical deterioration and in-hospital mortality without any clinical benefit.
AMR is already a paramount global threat. The http://WHOWHO estimates that bacterial resistance contributed to 1.27 million deaths in 2019 and may approach 10 million annual deaths by 2050 unless measures improve.
Antibiotic Stewardship at Center Stage
These guidelines align with the principles of antimicrobial stewardship (AMS) — promoting evidence-based, cautious antibiotic use to safeguard human health and reduce resistance. The WHO’s antibiotic classification system (AWaRe) further underscores the need to limit high-risk drugs to preserve effectiveness. This shift strengthens global efforts on rational prescribing, safeguarding patient safety and aligning COVID-19 care with broader public health priorities.
