Azithromycin consumption during the COVID-19 pandemic in Croatia, 2020

Bogdanić, Nikolina; Močibob, Loris; Vidović, Toni; Soldo, Ana; Begovać, Josip

doi:10.1101/2021.10.31.21265714

Cited by 5 publications

(5 citation statements)

References 19 publications

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“…Many clinical studies have shown that the use of azithromycin did not have any positive effect in the treatment of patients with COVID-19 infection (Del Fiol et al, 2022). In the newer version of the guidelines for the treatment of patients with COVID-19, strong recommendations were made against the use of azithromycin alone and azithromycin in combination with hydroxychloroquine and colchicine (Bogdanić et al, 2022;Del Fiol et al, 2022;Roche et al, 2022). Regarding inpatient settings, the hospital list of restricted antibiotics that require an approval from the designated infection control team when used consists of 15 antibiotics (piperacillin/ tazobactam, cefuroxime, ceftazidime, ceftriaxone, cefotaxime, cefepime, imipenem/cilastatin, meropenem, ertrapenem, vancomycin, colistin, clarithromycin, moxifloxacin, ciprofloxacin, and levofloxacin).…”

Section: Discussionmentioning

confidence: 99%

Antibiotic consumption and antimicrobial resistance in the SARS-CoV-2 pandemic: A single-center experience

et al. 2023

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Introduction: Antimicrobial resistance and the rapid spread of multiresistant bacteria represent one of the main public health problem in limited resources countries. This issue is significantly worsening since the COVID-19 pandemic due to the unreasonably increased antibiotics prescription to patients with confirmed SARS-CoV-2 infection. The aim of this study was to examine whether COVID-19 pandemic (2020, 2021) was associated with increased antibiotic consumption in inpatient and outpatient settings in the middle size urban region (Republic of Srpska/Bosnia and Herzegovina) in comparison to period before the pandemic (2019). Additionally, we aimed to determine antimicrobial resistance and the presence of multiresistant bacteria in the regional hospital (“Saint Apostol Luka” Hospital Doboj) in 2021.Methodology: The consumption of antibiotics in inpatient was calculated as Defined Daily Dose per one hundred of patient-days. The consumption of antibiotics in outpatient was calculated as Defined Daily Dose per thousand inhabitants per day. Resistance of bacteria to antibiotics is expressed as a rates and density for each observed antibiotic. The rate of resistance was calculated as a percentage in relation to the total number of isolates of individual bacteria. The density of resistance of isolated bacteria against a specific antibiotic was expressed as the number of resistant pathogens/1000 patient days.Results: Antibiotic consumption in hospital setting registered during 2019, 2020 and 2021 was as follows: carbapenems (meropenem: 0.28; 1.91; 2.33 DDD/100 patient-days, respectively), glycopeptides (vancomycin: 0.14; 1.09, 1.54 DDD/100 patient-days, respectively), cephalosporins (ceftriaxone: 6.69; 14.7; 14.0 DDD/100 patient-days, respectively) and polymyxins (colistin: 0.04; 0.25; 0.35 DDD/100 bed-days, respectively). Consumption of azithromycin increased drastically in 2020, and dropped significantly in 2021 (0.48; 5.61; 0.93 DDD/100 patient-days). In outpatient setting, an increase in the consumption of oral forms of azithromycin, levofloxacin and cefixime, as well as parenteral forms of amoxicillin-clavulanic acid, ciprofloxacin and ceftriaxone, was recorded. In 2021, antimicrobial resistance to reserve antibiotics in hospital setting was as follows: Acinetobacter baumanii to meropenem 66.0%, Klebsiella spp to cefotaxime 67.14%, Pseudomonas to meropenem 25.7%.Conclusion: Recent COVID-19 pandemic was associated with increased antibiotic consumption in inpatient and outpatient settings, with characteristic change of pattern of azithromycin consumption. Also, high levels of antimicrobial resistance to reserve antibiotics were registered in hospital setting with low prevalence of identified pathogen-directed antimicrobial prescription. Strategies toward combat antimicrobial resistance in the Doboj region are urgently needed.

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Section: Discussionmentioning

confidence: 99%

Antibiotic consumption and antimicrobial resistance in the SARS-CoV-2 pandemic: A single-center experience

et al. 2023

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“…Guidelines for treatment of COVID-19 issued by the Croatian Ministry of Health and the European Medical Agency in late 2020 did not include administration of empirical antibiotics ( 8 , 9 ). Despite the guidelines, latest data available in Croatia show an increase in the prescription of azithromycin in clear correlation with the increase of COVID-19 patients ( 10 ). However, reported rates of bacterial co-infections in COVID-19 patients are low.…”

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confidence: 99%

The effect of outpatient antibiotic treatment of coronavirus disease 2019 on the outcomes in the emergency department: a propensity score matching study

Atić¹,

Sorić²,

Stojić³

et al. 2022

Croat Med J

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Aim To determine the effect of outpatient oral antibiotics on coronavirus disease 2019 (COVID-19) in patients presenting to the emergency department. Methods This retrospective cohort study with propensity score matching conducted at University Hospital Dubrava collected data on all emergency department visits due to COVID-19 in November 2020. The primary outcome was hospital admission. The secondary outcomes were pneumonia development, respiratory failure, and required level of respiratory support. Results Overall, 1217 visits were evaluated and 525 patients were included in the analysis. After propensity score matching, 126 pairs of treated patients and controls were identified. Patients and controls did not differ in physical examination findings, laboratory test results, radiographic findings, or defined outcomes before and after matching. Conclusion This study suggests no benefit of empirical oral antibiotics for outpatient treatment of COVID-19. In patients presenting to the emergency department, prior oral antibiotic treatment did not affect hospital admission rates or the level of respiratory support required.

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“…Furthermore, while overall prescribing may have decreased, prescription of specific antibiotics has increased, particularly those associated with COVID-19 prophylaxis. For instance, community consumption of azithromycin increased during the first year of the pandemic in multiple countries [48][49][50]. Several studies have now characterized the wide range of antibiotics provided as prophylaxis to both mild and severe COVID-19 patients in 2020 [51,52], though it remains unclear to what extent prophylaxis is appropriate for prevention of bacterial coinfection in COVID-19 patients, particularly for mild cases treated in the community.…”

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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Azithromycin consumption during the COVID-19 pandemic in Croatia, 2020

Cited by 5 publications

References 19 publications

Antibiotic consumption and antimicrobial resistance in the SARS-CoV-2 pandemic: A single-center experience

Antibiotic consumption and antimicrobial resistance in the SARS-CoV-2 pandemic: A single-center experience

The effect of outpatient antibiotic treatment of coronavirus disease 2019 on the outcomes in the emergency department: a propensity score matching study

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

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