Antimicrobial use in Sweden during the COVID-19 pandemic: prescription fill and inpatient care requisition patterns

Abstract

Background Increased and inappropriate antimicrobial use are the key drivers of the emergence of antimicrobial resistance, and there have been widespread concerns around potential antimicrobial misuse, overuse and their consequences during the COVID-19 pandemic. To better understand the impact of the pandemic on antimicrobial use, particularly in light of the resurgence of COVID-19 cases since the summer of 2020, we assessed trends in antimicrobial prescription fills and hospital requisitions in Sweden during 2020 against those of preceding years. Methods We performed a descriptive study using population-based data from the Swedish Prescribed Drug Register and the Swedish e-Health Agency. The weekly number of prescriptions filled and the total volume sold to inpatient care institutions in defined daily doses (DDDs) per 1000 inhabitants for systemic antibacterials (Anatomical Therapeutic Chemical therapeutic subgroup J01 excluding J01XX), antimycotics (J02), antivirals (J05) and antiprotozoals (P01) were computed and evaluated from time series graphs. A time series linear regression with ordinary least squares (OLS) estimation was used to model 2015–2019 data and predict the expected number of prescriptions filled and volumes sold in DDDs per 1000 inhabitants during 2020 with 95% confidence limits. Results From mid-March 2020, the weekly rate of antibiotic and antiprotozoal prescriptions filled plummeted to unprecedentedly low levels for the rest of the year; while unprecedentedly high numbers of antiviral prescriptions were filled weekly between mid-February and mid-March 2020. There was a net reduction in annual dispensing of antibiotics by 17%; of antiprotozoals by 21%; and of antivirals by 0.3% during 2020 compared to 2019. Inpatient care requisitions of antiprotozoals and antibiotics surged to 6-year highs during March 2020, resulting in a 127% increase in DDDs of antiprotozoals sold from 2019. The volume of antibiotics and antivirals sold to inpatient care institutions in 2020 decreased by 3% and 13% compared to 2019, respectively. Conclusions The overall decline in antimicrobial prescriptions filled in Sweden during 2020 were in part, collateral dividends of the COVID-19 pandemic.

The impact of the COVID‐19 pandemic on antibiotic consumption and prevalence of pathogens in primary and secondary healthcare settings in Northern Ireland

“…Other‐ studies showed that the global trend of antibiotic consumption for the whole study period was stable 41 . Some studies have reported a decrease in the hospital‐based consumption of antibiotics during the COVID‐19 period compared to the pre‐COVID‐19 period 14,38 . However, we have observed that the consumption of first‐, second‐ and third‐generation cephalosporins in hospital settings during all waves of the pandemic was significantly increased.…”

“…41 Some studies have reported a decrease in the hospital-based consumption of antibiotics during the COVID-19 period compared to the pre-COVID-19 period. 14,38 However, we have observed that the consumption of first-, second-and third-generation cephalosporins in hospital settings during all waves of the pandemic was significantly increased. These changes were likely due in part to evolving guidance for the treatment of community-associated pneumonia in the presence of COVID-19 (NICE NG173) 44 and a desire to minimize drug administration time for nursing staff by the use of agents with a lower dosing frequency or with a preference for oral administration.…”

“…Despite the advice that antimicrobials should not be prescribed unless there is a concomitant bacterial or fungal infection, high antimicrobial consumption has been reported among patients with COVID‐19, particularly in the first wave of the pandemic and in lower to middle income countries 12–15,17–20 . A recent systematic review and meta‐analysis was conducted to determine bacterial co‐infections (identified within ≤48 h of presentation) and secondary infections (>48 h after presentation) in outpatients or hospitalized patients with COVID‐19 21 .…”

“…The pandemic created anxiety and uncertainty, and health professionals involved in treating COVID‐19 patients had an unprecedented workload which coalesced with high‐stress levels. This was intensified by the absence of effective antiviral treatments, contributing to the widespread and excessive prescription of antibiotics 10,13,14 . This response has exacerbated the existing issues with regard to antimicrobial overuse, misuse and the consequences 15,16 …”

“…This was intensified by the absence of effective antiviral treatments, contributing to the widespread and excessive prescription of antibiotics. 10,13,14 This response has exacerbated the existing issues with regard to antimicrobial overuse, misuse and the consequences. 15,16 Despite the advice that antimicrobials should not be prescribed unless there is a concomitant bacterial or fungal infection, high antimicrobial consumption has been reported among patients with COVID-19, particularly in the first wave of the pandemic and in lower to middle income countries.…”