Antibiotic Prescription Patterns in the Paediatric Primary Care Setting before and after the COVID-19 Pandemic in Italy: An Analysis Using the AWaRe Metrics

Abstract

The containment measures following COVID-19 pandemic drastically reduced airway infections, but they also limited the access of patients to healthcare services. We aimed to assess the antibiotic prescription patterns in the Italian paediatric primary care setting before and after the containment measures implementation. For this retrospective analysis, we used a population database, Pedianet, collecting data of patients aged 0–14 years enrolled with family paediatricians (FP) from March 2019 to March 2021. Antibiotic prescriptions were classified according to WHO AWaRe classification. An interrupted time series evaluating the impact of the containment measures implementation on the monthly antibiotic index, on the access to watch index, and on the amoxicillin to co-amoxiclav index stratified by diagnosis was performed. Overall, 121,304 antibiotic prescriptions were retrieved from 134 FP, for a total of 162,260 children. From March 2020, the antibiotic index dropped by more than 80% for respiratory infections. The Access to Watch trend did not change after the containment measures, reflecting the propensity to prescribe more broad-spectrum antibiotics for respiratory infections even during the pandemic. Similarly, co-amoxiclav was prescribed more often than amoxicillin alone for all the diagnoses, with a significant variation in the trend slope for upper respiratory tract infections prescriptions.

Reduction in broad-spectrum antimicrobial prescriptions by primary care pediatricians following a multifaceted antimicrobial stewardship program

“…Concerning the third class of indicators, we decided to describe the ratio between broad spectrum and narrow spectrum molecules using the Amoxicillin/Amoxicillin-Clavulanate index and Access/ Watch index, in the purpose of comparing our research with other ones conducted in similar settings and in the same study period. Two Italian studies based on the Pedianet network recorded from PCPs between 2019 and 2021 showed a reduction in the overall prescriptions ranging from 20% to about 80% (32,33). This data is consistent with the reduction observed in our study population, where the prescription rate dropped by about 65% of pre-implementation.…”

Antibiotics Use in Primary Care during COVID-19

“…Barbieri et al [ 6 ] observed even higher antibiotic prescribing reductions among Italian children compared to the previous paper, with an 80% reduction in antibiotic prescribing rates for children with respiratory tract infections compared to the pre-pandemic period. However, due to uncertainty, pediatricians tended to use more broad-spectrum antibiotics during the first few months of the pandemic, mainly for upper airway infections, such as amoxicillin and clavulanate, at the detriment of first-line antibiotics.…”

Exploration of Trends in Antimicrobial Use and Their Determinants Based on Dispensing Information Collected from Pharmacies throughout Japan: A First Report

“…While some countries show similar trends to Japan [13,22], in other countries the opposite trend has been observed because of telemedicine consultation resulting in overcautious physicians prescribing more antibiotics when faced with the limited diagnostics available [12,23]. Prescriptions of antibiotics increased in hospitals in some countries during the COVID-19 pandemic because physicians tended to prescribe "prophylactic antibiotics" to hospitalized COVID-19 patients almost by default [14,24,25].…”