Drug Prescriptions in the Outpatient Management of COVID-19: Evidence-Based Recommendations Versus Real Practice

Abstract

Background: Evidence-based recommendations for outpatient management of COVID-19 were published by the Italian Medicines Agency (AIFA) to limit the use of off-label treatments. The aim of this study is to measure the use of outpatient drug treatments in a COVID-19-positive population, taking into account the Italian regulatory agency’s advices.Methods: A descriptive observational study was conducted. All patients testing positive for COVID-19 residing in Lazio region, Italy, with diagnosis date between March 2020 and May 2021 were selected, and outpatient medicine prescription patterns were identified.Results: Independent of AIFA recommendations, the use of drug therapy in the management of outpatient COVID-19 cases was frequent (about one-third of the cases). The most used drug therapy was antibiotics, specifically azithromycin, despite the negative recommendation of AIFA, while the use of corticosteroids increased after the positive recommendation of regulatory agency for the use in subjects with severe COVID-19 disease. The use of hydroxychloroquine was limited to the early pandemic period where evidence on its potential benefit was controversial. Antithrombotics were widely used in outpatient settings, even if their use was recommended for hospitalized patients.Conclusion: In this study, we show a frequent use of drug therapy in the management of outpatient cases of COVID-19, mainly attributable to antibiotics use. Our research highlights the discrepancy between recommendations for care and clinical practice and the need for strategies to bridge gaps in evidence-informed decision-making.

Community antibiotic prescribing in patients with COVID-19 across three pandemic waves: a population-based study in Scotland, UK

“…Prescriptions were included from 3 days prepositive to 7 days postpositive test. 23% of cases received an antibiotic, with a notable increase from 18% of cases in November 2020 to 31% in March 2021 14. The overall rate is higher than in our study, and the increase over time is contrary to our findings, but they did not include data from wave 3.…”

“…Community antibiotic prescribing for individuals with COVID-19 is less well studied than for hospitalised patients or overall population trends 4 9 12 13. Of three previous relevant studies, in the USA,12 Italy14 and England,13 one used diagnostic codes rather than testing data and was limited to one medical insurance provider 12. Another examined patients-prescribed antibiotics during the COVID-19 pandemic and quantified how many of those had COVID-19 13.…”

Association between self-reported evidence-based medicine competencies and prescribing of drugs without scientific evidence against mild COVID-19 among recently graduated physicians in Peru

“…Among the most prescribed drugs, we found a high frequency of prescription of azithromycin, followed by ivermectin, other antibiotics, and dexamethasone. This is in agreement with what was reported in Italy [ 42 ], Pakistan [ 11 ] and different studies in Latin America [ 10 , 50 ], where a higher prescription of antibiotics such as azithromycin was found for the management of patients with COVID-19. This high prescription of antibiotics is to be expected, since it is a common practice for the management of respiratory infections, even before the pandemic [ 51 , 52 ], mainly offered with the intention of “avoiding complications” [ 53 ], and because of the pressure exerted by patients on professionals for their consumption [ 54 ].…”

“…Previous studies have shown that the prescription of non-evidence-based medications for the treatment of COVID-19 is frequent, ranging from 28 to 29% [ 42 , 43 ]. Furthermore, a previous study evaluated the factors influencing medication prescription for COVID-19 [ 44 ].…”

COVID-19 patient experiences in pre-hospital pathways: a processual qualitative approach using the life-events calendar method highlights diagnostic delays and healthcare renunciation.

“…Most studies on primary care management are reviews of the clinical recommendation literature [8, 9,10,11,12], and in general, most of the literature focuses on hospital management of COVID-19 [13,14,15,16,17,18]. Furthermore, no publication to date has investigated the implementation of primary care practice guidelines for the management of COVID-19 patients.…”