Antibiotic prescribing in general practice during COVID-19

Armitage, Richard; Nellums, Laura B

doi:10.1016/s1473-3099(20)30917-8

Cited by 77 publications

(84 citation statements)

References 3 publications

(3 reference statements)

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“…Reductions in presentation for common infections due to the COVID-19 pandemic were also found in other countries. The decrease in number of common infectious disease episodes for which a GP was consulted (from 27,263 to 23,442; −14%) in our study is slightly less pronounced than the reduction in overall number of primary care consultations (−21%) in the United Kingdom [ 8 ]. In the United States, a 40% relative reduction in childhoodAOM) incidence in primary and secondary care was observed [ 9 ].…”

Section: Discussionmentioning

confidence: 86%

Impact of the COVID-19 Pandemic on Antibiotic Prescribing for Common Infections in The Netherlands: A Primary Care-Based Observational Cohort Study

et al. 2021

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In 2020, the COVID-19 pandemic brought dramatic changes in the delivery of primary health care across the world, presumably changing the number of consultations for infectious diseases and antibiotic use. We aimed to assess the impact of the pandemic on infections and antibiotic prescribing in Dutch primary care. All patients included in the routine health care database of the Julius General Practitioners’ Network were followed from March through May 2019 (n = 389,708) and March through May 2020 (n = 405,688). We extracted data on consultations for respiratory/ear, urinary tract, gastrointestinal and skin infections using the International Classification of Primary Care (ICPC) codes. These consultations were combined in disease episodes and linked to antibiotic prescriptions. The numbers of infectious disease episodes (total and those treated with antibiotics), complications, and antibiotic prescription rates (i.e., proportion of episodes treated with antibiotics) were calculated and compared between the study periods in 2019 and 2020. Fewer episodes were observed during the pandemic months than in the same months in 2019 for both the four infectious disease entities and complications such as pneumonia, mastoiditis and pyelonephritis. The largest decline was seen for gastrointestinal infections (relative risk (RR), 0.54; confidence interval (CI), 0.51 to 0.58) and skin infections (RR, 0.71; CI, 0.67 to 0.75). The number of episodes treated with antibiotics declined as well, with the largest decrease seen for respiratory/ear infections (RR, 0.54; CI, 0.52 to 0.58). The antibiotic prescription rate for respiratory/ear infections declined from 21% to 13% (difference −8.0% (CI, −8.8 to −7.2)), yet the prescription rates for other infectious disease entities remained similar or increased slightly. The decreases in primary care infectious disease episodes and antibiotic use were most pronounced in weeks 15–19, mid-COVID-19 wave, after an initial peak in respiratory/ear infection presentation in week 11, the first week of lock-down. In conclusion, our findings indicate that the COVID-19 pandemic has had profound effects on the presentation of infectious disease episodes and antibiotic use in primary care in the Netherlands. Consequently, the number of infectious disease episodes treated with antibiotics decreased. We found no evidence of an increase in complications.

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Section: Discussionmentioning

confidence: 86%

Impact of the COVID-19 Pandemic on Antibiotic Prescribing for Common Infections in The Netherlands: A Primary Care-Based Observational Cohort Study

et al. 2021

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“…With less face-to-face care, and increased telemedicine in HIC, there may be some use of antibiotics in primary care ‘rescue packs’ ( Health and Social Care Board (HCSB), 2020 ) and, where fewer microbiological samples can be taken, more antibiotics prescribed ‘just in case’. A potential signal of this has been seen in data from the UK ( Armitage and Nellums, 2020 ; MacKenna, 2020 ) and likely increased prescribing for dental care ( Croser, 2020 ). Messages around antimicrobial stewardship need to be tailored to these varied and changing landscapes ( De Waele et al, 2021 ; Seaton, 2020 ).…”

Section: Covid-19 Impact On Amrmentioning

confidence: 99%

“…However, in the longer term, those who delay treatment could have worse outcomes, leading to higher rates of hospitalisation and the need for more or different antibiotics. For example, in England there has been an up to 50% reduction in Accident and Emergency attendance in some regions ( NHS England, 2020 ) and a 20% reduction in appointments ( Armitage and Nellums, 2020 ). In the community in England, a reduction in prescriptions for some antibiotics has been seen, for example, for those used to treat skin and urinary tract infections (flucloxacillin and nitrofurantoin and trimethoprim) ( MacKenna, 2020 ), but due to the decrease in the total number of appointments the number of antibiotic prescriptions was higher than expected ( Armitage and Nellums, 2020 ).…”

Section: Covid-19 Impact On Amrmentioning

confidence: 99%

“…For example, in England there has been an up to 50% reduction in Accident and Emergency attendance in some regions ( NHS England, 2020 ) and a 20% reduction in appointments ( Armitage and Nellums, 2020 ). In the community in England, a reduction in prescriptions for some antibiotics has been seen, for example, for those used to treat skin and urinary tract infections (flucloxacillin and nitrofurantoin and trimethoprim) ( MacKenna, 2020 ), but due to the decrease in the total number of appointments the number of antibiotic prescriptions was higher than expected ( Armitage and Nellums, 2020 ). A substantial proportion of these prescriptions may have been unnecessary, inappropriate antibiotic prescriptions ( Pouwels et al, 2018 ; Smieszek et al, 2018 ) for self-limiting or viral infections, potentially driven by telemedicine, but again it cannot yet be estimated how many of these patients needed antibiotics and may suffer from later complications.…”

Section: Covid-19 Impact On Amrmentioning

confidence: 99%

“…To counter this reduction in health-seeking behaviour, some healthcare settings are turning to telemedicine ( Croser, 2020 ; Hollander and Carr, 2020 ; Rawson et al, 2020b ), but the extent to which the inability to see a patient in person leads to ‘just in case’ antibiotic prescribing, and further increases in AMR, is unknown ( Armitage and Nellums, 2020 ). Telemedicine is also not an option in many settings in the world.…”

Section: Covid-19 Impact On Amrmentioning

confidence: 99%

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Antimicrobial resistance and COVID-19: Intersections and implications

Knight

Glover

McQuaid

et al. 2021

eLife

247

212

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Before the coronavirus 2019 (COVID-19) pandemic began, antimicrobial resistance (AMR) was among the top priorities for global public health. Already a complex challenge, AMR now needs to be addressed in a changing healthcare landscape. Here, we analyse how changes due to COVID-19 in terms of antimicrobial usage, infection prevention, and health systems affect the emergence, transmission, and burden of AMR. Increased hand hygiene, decreased international travel, and decreased elective hospital procedures may reduce AMR pathogen selection and spread in the short term. However, the opposite effects may be seen if antibiotics are more widely used as standard healthcare pathways break down. Over 6 months into the COVID-19 pandemic, the dynamics of AMR remain uncertain. We call for the AMR community to keep a global perspective while designing finely tuned surveillance and research to continue to improve our preparedness and response to these intersecting public health challenges.

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Comparison of Medication Prescribing Before and After the COVID-19 Pandemic Among Nursing Home Residents in Ontario, Canada

et al. 2021

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Key Points Question How are COVID-19 and related disruptions in care associated with changes in the dispensation of medications commonly used among nursing home residents? Findings In this population-based cohort study with an interrupted time-series analysis of all nursing home residents from the 630 facilities in Ontario, Canada, the emergence of the COVID-19 pandemic was associated with significant increases in the use of antipsychotics, benzodiazepines, antidepressants, anticonvulsants, and opioids and no meaningful changes in the use of antibiotics or selected cardiovascular medications. Meaning The finding of increased use of medications with the potential for adverse effects among nursing home residents during the initial wave of the pandemic warrants ongoing monitoring for prescribing appropriateness and related resident outcomes.

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Antibiotic prescribing in general practice during COVID-19

Cited by 77 publications

References 3 publications

Impact of the COVID-19 Pandemic on Antibiotic Prescribing for Common Infections in The Netherlands: A Primary Care-Based Observational Cohort Study

Impact of the COVID-19 Pandemic on Antibiotic Prescribing for Common Infections in The Netherlands: A Primary Care-Based Observational Cohort Study

Antimicrobial resistance and COVID-19: Intersections and implications

Comparison of Medication Prescribing Before and After the COVID-19 Pandemic Among Nursing Home Residents in Ontario, Canada

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