Antibiotic Prescribing Trends in Belgian Out-of-Hours Primary Care during the COVID-19 Pandemic: Observational Study Using Routinely Collected Health Data

Abstract

Antibiotic overprescribing is one of the main drivers of the global and growing problem of antibiotic resistance, especially in primary care and for respiratory tract infections (RTIs). RTIs are the most common reason for patients to consult out-of-hours (OOH) primary care. The COVID-19 pandemic has changed the way general practitioners (GPs) work, both during office hours and OOH. In Belgian OOH primary care, remote consultations with the possibility of issuing prescriptions and telephone triage were implemented. We aimed to describe the impact of COVID-19 on GPs’ antibiotic prescribing during OOH primary care. In an observational study, using routinely collected health data from GP cooperatives (GPCs) in Flanders, we analyzed GPs’ antibiotic prescriptions in 2019 (10 GPCs) and 2020 (20 GPCs) during OOH consultations (telephone and face-to-face). We used autoregressive integrated moving average (ARIMA) modeling to identify any changes after lockdowns were implemented. In total, 388,293 contacts and 268,430 prescriptions were analyzed in detail. The number of antibiotic prescriptions per weekend, per 100,000 population was 11.47 (95% CI: 9.08–13.87) or 42.9% lower after compared to before the implementation of lockdown among all contacts. For antibiotic prescribing per contact, we found a decrease of 12.2 percentage points (95% CI: 10.6–13.7) or 56.5% among all contacts and of 5.3 percentage points (95% CI: 3.7–6.9) or 23.2% for face-to-face contacts only. The decrease in the number of prescriptions was more pronounced for cases with respiratory symptoms that corresponded with symptoms of COVID-19 and for antibiotics that are frequently prescribed for RTIs, such as amoxicillin (a decrease of 64.9%) and amoxicillin/clavulanate (a decrease of 38.1%) but did not appear for others such as nitrofurantoin. The implementation of COVID-19 lockdown measures coincided with an unprecedented drop in the number of antibiotic prescriptions, which can be explained by a decrease in face-to-face patient contacts, as well as a lower number of antibiotics prescriptions per face-to-face patient contact. The decrease was seen for antibiotics used for RTIs but not for nitrofurantoin, the first-choice antibiotic for urinary tract infections.

Self-Reported Medication Use among Pregnant and Breastfeeding Women during the COVID-19 Pandemic: A Cross-Sectional Study in Five European Countries

“…[10,15]. A decreased rate of antibiotic consumption was also recently observed in the primary care population [19,21,32], and might be explained by the widespread infection control measures taken in the fight against SARS-CoV-2. It is also likely that the limited (physical) access to perinatal healthcare services during the pandemic led to a decreased likelihood of getting a prescription for antibiotics [3,4].…”

“…Examples of this include the publication of premature assumptions on the beneficial or detrimental effects of medications on COVID-19 outcomes (e.g., hydroxychloroquine, non-steroidal anti-inflammatory drugs) [17,18]. Other publications have shown that some medications have been used or dispensed to a lesser extent within the general public (i.e., antibiotics, insulin) [19][20][21], whereas other medications have been prescribed or dispensed more often (i.e., psychotropics and antidepressants) [22][23][24]. However, the extent to which this phenomenon is applicable to pregnant and breastfeeding women remains unclear.…”

Antibiotic Prescribing in Dutch Daytime and Out-of-Hours General Practice during the COVID-19 Pandemic: A Retrospective Database Study

“…For example, it has been suggested that the change from face-to-face consultations to remote consultations may have led to an increase in the prescribing of antibiotics, to overcome diagnostic uncertainty caused by the inability to perform physical examinations during remote consultations [7,8]. However, similar or less antibiotic prescribing during remote consultations has been observed as well [9][10][11]. Nevertheless, remote consultations where no antibiotic was prescribed may have been followed by face-to-face follow-up consultations.…”

“…Moreover, since the start of the COVID-19 pandemic, a substantial decrease in antibiotic prescriptions was observed in most European countries on top of the already declining prescription rates over the last years [12]. This reduction was observed both in DGPs and OOH-services [10,13]. Some studies suggest that the reduction of antibiotic prescribing is linked to the reduced transmission of respiratory tract infections (RTIs) as this coincided with fewer prescriptions or dispensations of antibiotics for RTIs [10,14,15].…”

“…This reduction was observed both in DGPs and OOH-services [10,13]. Some studies suggest that the reduction of antibiotic prescribing is linked to the reduced transmission of respiratory tract infections (RTIs) as this coincided with fewer prescriptions or dispensations of antibiotics for RTIs [10,14,15]. On the other hand, the antibiotic prescription rate for UTIs seems to stay comparable to pre-pandemic levels [15][16][17].…”