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

Abstract

Background During the initial phase of the COVID-19 pandemic, there was great enthusiasm for the use of azithromycin with or without hydroxychloroquine. Objectives We analyzed azithromycin consumption in Croatia in 2020 and compared this to the period 2017–2019. Methods Azithromycin consumption was evaluated using the IQVIA Adriatic d.o.o. database which collects data on azithromycin distribution from wholesale pharmacies to hospital and non-hospital pharmacies in Croatia. We analyzed data for the period from January 2017 to December 2020. Azithromycin distribution was measured as days of therapy (DOT) and reported as per 1000 inhabitants or per 1000 inhabitant-days. Results In the period 2017–2020, total azithromycin DOT in Croatia increased in 2017, 2018, 2019, and 2020 (1.76, 1.91, 1.91 and 2.01/1000 inhabitant-days, respectively). Non-hospital pharmacies received 2.18 times and hospital pharmacies 4.39 times more DOT units/1000 inhabitants of azithromycin in March 2020 compared to the average distribution rate in March 2017–2019. During the peak of the COVID-19 epidemic (November and December 2020) azithromycin distribution increased considerably in hospital (3.62 and 3.19 times, respectively) and non-hospital pharmacies (1.93 and 1.84 times, respectively) compared to the average consumption in the same months in 2017–2019. Conclusions Our data showed increased azithromycin distribution in the period 2017–2020 which indicates azithromycin overuse. Preliminary information on COVID-19 treatments with a desire to offer and try what is available even in the absence of strong scientific evidence may have influenced practices of antimicrobial prescriptions.

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

“…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).…”

Consumption of Antibiotics in Primary Care Setting before and during COVID-19 Pandemic in Republic of Srpska, Bosnia and Herzegovina

“…Contrary to the results of our study, in 2020 there was a decrease in consumption of first-generation cephalosporins and amoxicillin in Brazil, which was explained by a decrease in all respiratory infections except for COVID-19 [ 24 ]. The consumption of macrolides was significantly higher in 2020 compared to 2019 in all regions of the RS, which was also registered in all neighboring countries and globally [ 25 ]. The increased consumption of azithromycin is explained by its previously proven immunomodulatory and antiviral effect, which along with antibacterial effect protects against the worsening of viral infections [ 26 , 27 ].…”

Antibacterial efficacy of indigenous Pakistani honey against extensively drug-resistant clinical isolates of Salmonella enterica serovar Typhi: an alternative option to combat antimicrobial resistance

“…The presence of MDR and XDR pathogens is primarily due to the overuse of antibiotics. Azithromycin is one of the drugs excessively used during the COVID-19 pandemic globally [ 31 – 33 ], and the emergence of S . Typhi resistant to azithromycin has been reported in different parts of the world [ 9 , 34 ].…”