Antibiotic Use in Suspected and Confirmed COVID-19 Patients Admitted to Health Facilities in Sierra Leone in 2020–2021: Practice Does Not Follow Policy
, Ajay M. V. Kumar 2,3,4, Anna Maruta 1, Bobson Derrick Fofanah 1, Charles Kuria Njuguna 1, Steven Shongwe 1, Francis Moses 5, Sia Morenike Tengbe 5, Joseph Sam Kanu 6,7, Sulaiman Lakoh 5, Alie H. D. Mansaray 8, Kalaiselvi Selvaraj 9, Mohammed Khogali 10 and Rony Zachariah 10Round 1
Reviewer 1 Report
The paper is intersting, however the audience could be limited.
There are only few minor questions, which should be addressed prior publication.
- Please clarify the aim of the study.
- Line 156: please include the information concerning total number of analyzed cases.
- Line 357: please give the examples of recomendations.
Author Response
Comment 1: Please clarify the aim of the study
Response: Thank you, we have clarified the aim of the study in the revised paper.
Comment 2: Line 156: please include the information concerning total number of analyzed cases.
Response: Thank you, we have included the information as requested.
Comment 3: Line 357: please give the examples of recommendations
Response: Thank you for the comment. We have expanded upon this section and added specific recommendations.
Reviewer 2 Report
I consider it a very interesting article, especially in view of the fact that it brings a point of view on three important aspects, the use of antibiotics in general, the use of antibiotics in viral infections, and the use of antibiotics in African countries (in this case Sierra Leone ), but maybe in the near future other researchers will follow this example.
Please see the attachment.
Comments for author File: 
Comments.pdf
Author Response
Comment 1: What does AWaRe means for the reader
Response: Thank you very much for the comment. We explained in detail the meaning of AWaRe classification in the methods section of the paper (Line 143)
Comment 2: Hyperbilirubinemia without period
Response: Thank you very much for the comment. This is how the disease classification for critical case as stated in the WHO guideline.
Comment 3: What is the author opinion about the high percentage of antibiotic use
Response: Thank you very much for the much. We have stated our opinion on the high use of antibiotic by clinicians during the early phase of the pandemic in lines 332-333
Reviewer 3 Report
This is an interesting manuscript by Ibrahim Franklyn Kamara et al. and also timely relevant. I read the manuscript and it appears that there has been inappropriate use of antibiotics in Covid patients in health facilities in Sierra Leone in 2020-21. This can result in ARGs selection and could cause serious public health concern. The authors studied this phenomenon in all age groups. It would be better, if authors can improve the abstract a bit more related to what class of antibiotics used more frequently and major findings rather in overview. Similarly, the conclusion has to be revised.
Author Response
Comment: It would be better, if authors can improve the abstract a bit more related to what class of antibiotics used more frequently and major findings rather in overview. Similarly, the conclusion has to be revised.
Response: Thank you. We have made the changes in the abstract and the conclusion as suggested.
