Antibiotic Utilization during COVID-19: Are We Over-Prescribing?

Bednarčuk, Nataša; Jelić, Ana Golić; Šatara, Svjetlana Stoisavljević; Stojaković, Nataša; Peković, Vanda Marković; Stojiljković, Miloš P.; Popović, Nina; Škrbić, Ranko

doi:10.3390/antibiotics12020308

Cited by 23 publications

(17 citation statements)

References 52 publications

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“…While scientific bodies have suggested that azithromycin’s antibacterial and anti-inflammatory properties may be useful in the empirical treatment of pulmonary co-infections in COVID-19 patients, the evidence for its direct activity in COVID-19 has been largely inconclusive [ 83 , 84 ]. Although clinical trials, such as RECOVERY, PRINCIPLE, and COALITION II, showed the lack of efficacy of azithromycin on clinical outcomes [ 85 , 86 , 87 ], several studies confirmed that azithromycin was the most commonly prescribed antibiotic during the COVID-19 pandemic [ 88 , 89 , 90 ].…”

Section: Discussionmentioning

confidence: 99%

The Hidden Cost of COVID-19: Focus on Antimicrobial Resistance in Bloodstream Infections

Micheli,

Sangiorgi,

Catania

et al. 2023

Microorganisms

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Antibiotic resistance is one of the greatest growing public health threats and a worldwide priority. According to the WHO, drug-resistant diseases may cause 10 million deaths a year by 2050 and have a substantial impact on the global economy, driving up to 24 million people into poverty. The ongoing COVID-19 pandemic has exposed the fallacies and vulnerability of healthcare systems worldwide, displacing resources from existing programs and reducing funding for antimicrobial resistance (AMR) fighting efforts. Moreover, as already seen for other respiratory viruses, such as flu, COVID-19 is often associated with superinfections, prolonged hospital stays, and increased ICU admissions, further aggravating healthcare disruption. These events are accompanied by widespread antibiotic use, misuse, and inappropriate compliance with standard procedures with a potential long-term impact on AMR. Still, COVID-19-related measures such as increasing personal and environmental hygiene, social distancing, and decreasing hospital admissions could theoretically help the AMR cause. However, several reports have shown increased antimicrobial resistance during the COVID-19 pandemic. This narrative review focuses on this “twindemic”, assessing the current knowledge of antimicrobial resistance in the COVID-19 era with a focus on bloodstream infections and provides insights into the lessons learned in the COVID-19 field that could be applied to antimicrobial stewardship initiatives.

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Section: Discussionmentioning

confidence: 99%

The Hidden Cost of COVID-19: Focus on Antimicrobial Resistance in Bloodstream Infections

Micheli,

Sangiorgi,

Catania

et al. 2023

Microorganisms

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“…The reasons for this trend are uncertain. However, this may demonstrate the considerable focus on managing patients with COVID-19 in Albania since the start of the pandemic, with this trend matching the increasing use of antibiotics seen in other countries during the pandemic [48,50,51]. This trend is difficult to justify as there is little evidence of bacterial infections in these patients [51,63,64].…”

Section: Discussionmentioning

confidence: 99%

“…Alongside this, we are aware that there has been an appreciable increase in the use of antibiotics in patients with COVID-19 across countries and sectors despite limited evidence of bacterial infections or co-infections [48][49][50][51][52][53], which might represent significant levels of inappropriate use. Consequently, there is also a need to examine antibiotic utilization trends during the pandemic in Albania alongside the implications.…”

Section: Introductionmentioning

confidence: 99%

11-Year Trend in Antibiotic Consumption in a South-Eastern European Country; the Situation in Albania and the Implications for the Future

et al. 2023

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There are growing concerns with rising antimicrobial resistance (AMR) across countries. These concerns are enhanced by the increasing and inappropriate utilization of ‘Watch’ antibiotics with their greater resistance potential, AMR is further exacerbated by the increasing use of antibiotics to treat patients with COVID-19 despite little evidence of bacterial infections. Currently, little is known about antibiotic utilization patterns in Albania in recent years, including the pandemic years, the influence of an ageing population, as well as increasing GDP and greater healthcare governance. Consequently, total utilization patterns in the country were tracked from 2011 to 2021 alongside key indicators. Key indicators included total utilization as well as changes in the use of ‘Watch’ antibiotics. Antibiotic consumption fell from 27.4 DIDs (defined daily doses per 1000 inhabitants per day) in 2011 to 18.8 DIDs in 2019, which was assisted by an ageing population and improved infrastructures. However, there was an appreciable increase in the use of ‘Watch’ antibiotics during the study period. Their utilization rose from 10% of the total utilization among the top 10 most utilized antibiotics (DID basis) in 2011 to 70% by 2019. Antibiotic utilization subsequently rose after the pandemic to 25.1 DIDs in 2021, reversing previous downward trends. Alongside this, there was increasing use of ‘Watch’ antibiotics, which accounted for 82% (DID basis) of the top 10 antibiotics in 2021. In conclusion, educational activities and antimicrobial stewardship programs are urgently needed in Albania to reduce inappropriate utilization, including ‘Watch’ antibiotics, and hence AMR.

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“…Community consumption of azithromycin, a macrolide, increased during the first year of the pandemic in multiple countries with significant variation across geographic locations and with greatest prescribing among older patients (Bara et al, 2022; Bednarčuk et al, 2023; Bogdanić et al, 2022; Crisafulli et al, 2022; Parveen et al, 2020; Weill et al, 2021). In an outpatient setting in southern Italy between February 2020 and January 2021, azithromycin represented 42.1% of all drug prescriptions to individuals diagnosed with COVID-19, while all other antibiotics combined represented just 20.9% (Crisafulli et al, 2022).…”

Section: Discussionmentioning

confidence: 99%

Revealing the drivers of antibiotic resistance trends inStreptococcus pneumoniaeamidst the 2020 COVID-19 pandemic: Insights from mathematical modeling

Kovacevic

Smith

Rahbé

et al. 2022

Preprint

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COVID-19 pandemic responses have dramatically modified the global ecological and epidemiological landscape of many infectious diseases. However, the pandemic’s impacts on antimicrobial resistance (AMR) are currently poorly understood and lack data. While surges in COVID-19 cases during the first wave of the pandemic may have exacerbated AMR, decreases in antibiotic use may have had the opposite effect. To disentangle how pandemic impacts such as lockdowns and modified antibiotic prescribing may affect AMR, we developed a mathematical model formalizing simultaneous transmission of SARS-CoV-2 and colonization with a bacterial pathogen across six pandemic scenarios. We used simulation to assess the effect of each scenario on the bacterial carriage prevalence, antibiotic resistance rate, and the invasive bacterial disease (IBD) incidence, using parameters based on the commensal community bacterium Streptococcus pneumoniae. Pandemic scenarios without community-wide lockdowns all resulted in a decrease in carriage prevalence of antibiotic-sensitive bacteria and an increase in the prevalence of antibiotic-resistant bacteria, while the addition of a population-wide lockdown resulted in a large reduction in colonization prevalence and IBD incidence for both strains (>70%). This translated to an increase in the antibiotic resistance rate across all scenarios to varying degrees, with lingering effects after the cessation of COVID-19 response measures. In the absence of lockdown, a population-wide surge in antibiotic prescribing coincident with the peak in SARS-CoV-2 infection resulted in the greatest increases in resistance rate (23%) and resistant IBD incidence (6%). Within-host interactions, SARS-CoV-2 variants, and population immunity are found to further drive the magnitude of pandemic impacts on resistant IBD incidence. Sensitivity analyses suggest that the extent of such impacts likely varies across different bacterial species. Although real-life scenarios are significantly more complicated, our findings suggest that COVID-19 pandemic responses may significantly impact antibiotic resistance in the community and support the need for monitoring resistance during pandemic waves.

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Antibiotic Utilization during COVID-19: Are We Over-Prescribing?

Cited by 23 publications

References 52 publications

The Hidden Cost of COVID-19: Focus on Antimicrobial Resistance in Bloodstream Infections

The Hidden Cost of COVID-19: Focus on Antimicrobial Resistance in Bloodstream Infections

11-Year Trend in Antibiotic Consumption in a South-Eastern European Country; the Situation in Albania and the Implications for the Future

Revealing the drivers of antibiotic resistance trends inStreptococcus pneumoniaeamidst the 2020 COVID-19 pandemic: Insights from mathematical modeling

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