Appropriateness of Antibiotic Prescriptions in Chinese Primary Health Care and the Impact of the COVID-19 Pandemic: A Typically Descriptive and Longitudinal Database Study in Yinchuan City

Abstract

Background: The appropriateness of antibiotic prescriptions in primary care has not been well evaluated in China in recent years. Furthermore, the impact of coronavirus disease 2019 (COVID-19) on antibiotic prescriptions has not yet been investigated in China. We aimed to assess the appropriateness of antibiotic prescriptions and to evaluate the potential association between the COVID-19 pandemic and antibiotic prescriptions in primary care settings of Yinchuan, a city in China.Methods: This study included 155 primary care institutions and 10,192,713 outpatient visits. Outpatient prescriptions were classified as appropriate, potentially appropriate, inappropriate, or not linked to any diagnosis for antibiotic use following a validated evaluation scheme. Interrupted time-series analyses were performed to assess the effects of the COVID-19 pandemic on antibiotic prescriptions in Chinese primary care facilities.Results: During the study period, 1,287,678 (12.6%, 95% confidence interval [12.6–12.7]) of 10,192,713 outpatient visits in primary care resulted in antibiotic prescriptions. Among 1,287,678 antibiotic prescriptions, 653,335 (50.7% [50.6–50.9]) were inappropriate, 463,081 (36.0% [35.8–36.1]) were potentially appropriate, 171,056 (13.3% [13.1–13.5]) were appropriate, and 206 could not be linked to any diagnosis. Furthermore, patient, physician, and institutional factors were associated with inappropriate antibiotic prescriptions; there was an overall decreasing trend in the proportions of inappropriate antibiotic prescriptions, with the highest level in 2017 (67.1% [66.8–67.5]) and the lowest in 2021 (40.8% [40.3–41.3]). A total of 1,416,120 individual antibiotics were prescribed, of which 1,087,630 (76.8%) were broad-spectrum and 777,672 (54.9%) were classified in the World Health Organization’s “Watch” category. In addition, the COVID-19 pandemic was associated with changes of −2.8% (−4.4 to −1.3) in the level and 0.3% (0.2–0.3) in the monthly trend of antibiotic prescription rates, as well as changes of −5.9% (−10.2 to −1.5) in the level and 1.3% (1.0–1.6) in the monthly trend of the proportions of inappropriate antibiotic prescriptions.Conclusion: More than half of the antibiotic prescriptions were inappropriate during the study period in primary care in Yinchuan. The COVID-19 pandemic may be associated with a decrease in the overall and inappropriate use of antibiotics in primary care settings in China.

Antibiotic use in township hospitals during the COVID-19 pandemic in Shandong, China

“…Especially, the number of prescriptions of certain categories of antibacterials (e.g., third-generation cephalosporins, fluoroquinolones) decreased significantly [ 11 , 12 , 14 – 16 ]. Similarly, several studies in China also found that there was a decline antibiotic consumption during the COVID-19 pandemic [ 17 – 19 ]. For example, a study from Yinchuan of China showed that the decrease in inappropriate antibiotic prescriptions in primary care settings may be associated with the COVID-19 pandemic [ 19 ].…”

“…The Coronavirus Disease-19 (COVID-19) pandemic swept across the world quickly and placed a heavy burden on the health systems globally. The impacts of the COVID-19 pandemic on antibiotic consumption and the risk of AMR have become a concern of many researchers of antibiotic resistance [ 11 – 19 ]. According to a report, after the outbreak of the COVID-19 pandemic in most European countries, the total consumption of antibiotics declined by more than 15%, which was mainly observed in PHSs [ 13 ].…”

Antibiotic use in township hospitals during the COVID-19 pandemic in Shandong, China

“…The Coronavirus Disease-19 (COVID-19) pandemic swept across the world quickly and placed a heavy burden on the health systems globally. The impacts of the COVID-19 pandemic on antibiotic consumption and the risk of AMR have aroused the attention of many researchers of antibiotic resistance [11][12][13][14][15][16][17][18][19]. A report stated that after the outbreak of the COVID-19 pandemic in most European countries, the total consumption of antibiotics declined by more than 15%, which was mainly observed in PHSs [13].…”

“…In China, a few similar studies also found that there was a decline in consumption of antibiotics during the . For example, a study from Yinchuan, China showed that the decrease in inappropriate antibiotic prescriptions in primary care settings may be associated with the COVID-19 pandemic [19]. It can be seen that the antibiotic use pattern may have changed greatly during the COVID-19 pandemic, but currently, there is no adequate evidence for the changes in antibiotic consumption in PHSs in China.This study aimed to assess the immediate and long-term impacts of the COVID-19 pandemic on the changes in antibiotic consumption in PHSs in Shandong, China.…”

“…Therefore, it is necessary to optimize antibiotic use in PHSs for containing bacterial resistance [4, 6,10].The Coronavirus Disease-19 (COVID-19) pandemic swept across the world quickly and placed a heavy burden on the health systems globally. The impacts of the COVID-19 pandemic on antibiotic consumption and the risk of AMR have aroused the attention of many researchers of antibiotic resistance [11][12][13][14][15][16][17][18][19]. A report stated that after the outbreak of the COVID-19 pandemic in most European countries, the total consumption of antibiotics declined by more than 15%, which was mainly observed in PHSs [13].Several national studies conducted in the USA, Portugal, Canada, and the UK also showed that a signi cant decrease was observed in the overall antibiotic consumption by outpatients or in broadspectrum antibiotic prescriptions during the COVID-19 pandemic; especially, the number of prescriptions of certain categories of antibacterials (e.g., third-generation cephalosporins, uoroquinolones) decreased signi cantly [11,12,[14][15][16].…”