Impact of Remote Consultations on Antibiotic Prescribing in Primary Health Care: Systematic Review

Han, Seung Min; Greenfield, Geva; Majeed, Azeem; Hayhoe, Benedict

doi:10.2196/23482

Cited by 61 publications

(65 citation statements)

References 27 publications

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“…We will also need to evaluate the longer-term impact of a shift to remote consultations in primary care on antibiotic prescribing and clinical outcomes such as delayed treatment of bacterial infections, increase in hospital admissions and deaths [27].…”

Section: Discussionmentioning

confidence: 99%

Investigating the impact of COVID-19 on primary care antibiotic prescribing in North West London across two epidemic waves

Zhu

Aylin

Rawson

et al. 2021

Clinical Microbiology and Infection

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Section: Discussionmentioning

confidence: 99%

Investigating the impact of COVID-19 on primary care antibiotic prescribing in North West London across two epidemic waves

Zhu

Aylin

Rawson

et al. 2021

Clinical Microbiology and Infection

Self Cite

View full text Add to dashboard Cite

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“…In the UK this rise in antibiotic prescribing has been attributed to the increase in remote consultations [ 8 ]. A recent systematic review expressed concern about studies in the past (all performed pre-pandemic) indicating higher prescription rates in remote than in face-to-face consultations [ 10 ]. Although we did find an increase in remote consultations during the pandemic similar to the UK (+268% in the Netherlands and +270% in the UK [ 8 ]), we did not find an increase in antibiotic use.…”

Section: Discussionmentioning

confidence: 99%

Impact of the COVID-19 Pandemic on Antibiotic Prescribing for Common Infections in The Netherlands: A Primary Care-Based Observational Cohort Study

et al. 2021

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In 2020, the COVID-19 pandemic brought dramatic changes in the delivery of primary health care across the world, presumably changing the number of consultations for infectious diseases and antibiotic use. We aimed to assess the impact of the pandemic on infections and antibiotic prescribing in Dutch primary care. All patients included in the routine health care database of the Julius General Practitioners’ Network were followed from March through May 2019 (n = 389,708) and March through May 2020 (n = 405,688). We extracted data on consultations for respiratory/ear, urinary tract, gastrointestinal and skin infections using the International Classification of Primary Care (ICPC) codes. These consultations were combined in disease episodes and linked to antibiotic prescriptions. The numbers of infectious disease episodes (total and those treated with antibiotics), complications, and antibiotic prescription rates (i.e., proportion of episodes treated with antibiotics) were calculated and compared between the study periods in 2019 and 2020. Fewer episodes were observed during the pandemic months than in the same months in 2019 for both the four infectious disease entities and complications such as pneumonia, mastoiditis and pyelonephritis. The largest decline was seen for gastrointestinal infections (relative risk (RR), 0.54; confidence interval (CI), 0.51 to 0.58) and skin infections (RR, 0.71; CI, 0.67 to 0.75). The number of episodes treated with antibiotics declined as well, with the largest decrease seen for respiratory/ear infections (RR, 0.54; CI, 0.52 to 0.58). The antibiotic prescription rate for respiratory/ear infections declined from 21% to 13% (difference −8.0% (CI, −8.8 to −7.2)), yet the prescription rates for other infectious disease entities remained similar or increased slightly. The decreases in primary care infectious disease episodes and antibiotic use were most pronounced in weeks 15–19, mid-COVID-19 wave, after an initial peak in respiratory/ear infection presentation in week 11, the first week of lock-down. In conclusion, our findings indicate that the COVID-19 pandemic has had profound effects on the presentation of infectious disease episodes and antibiotic use in primary care in the Netherlands. Consequently, the number of infectious disease episodes treated with antibiotics decreased. We found no evidence of an increase in complications.

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“…The results from other research are inconclusive. Prescribing according to the guidelines was sustained when switching from face-to-face to remote prescribing for sinusitis, but mixed data was found for acute respiratory infections [ 55 ]. Putting these results in the perspective of the COVID-19 pandemic with the implementation of preventive measures and accounting for the decrease in community-acquired infections, it is likely that the overall antibiotics prescribed in primary and outpatient settings has decreased, but due to remote prescribing, the proportion of appropriate prescriptions may have also decreased.…”

Section: Antibiotic Prescribing For Covid-19 and The Unnecessary Umentioning

confidence: 99%

Implications of COVID-19 Pandemic on the Emergence of Antimicrobial Resistance: Adjusting the Response to Future Outbreaks

Rušić

Vilović

Bukic

et al. 2021

Life

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The net effect of the coronavirus disease 2019 (COVID-19) pandemic and the response to it on the emergence of antimicrobial resistance is yet unknown. Positive impacts on the spread of multiresistant pathogens and infections in general may be observed with the implementation of general preventative measures for the spread of infectious disease such as social distancing, reduced travel and increased personal hygiene. This pandemic has accelerated the development of novel technologies, such as mRNA vaccines, that may be used to fight other diseases. These should be capitalized upon to manage the ongoing antimicrobial resistance pandemic in the background. However, it is likely that the COVID-19 pandemic is fueling the emergence of antimicrobial resistance due to high rates of inappropriate antimicrobial prescribing, the high use of biocides and the interruption of treatment for other conditions. Clinical uncertainty driven by the lack of effective diagnostics and practice of telemedicine may have driven the inappropriate use of antimicrobials. As pathogens know no borders, increased focus is needed for infectious diseases still threatening low- and middle-income countries such as tuberculosis. Stewardship measures for future outbreaks should stress the importance of social distancing and hand washing but discourage the overuse of disinfectants and antimicrobials that are not proven effective.

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Impact of Remote Consultations on Antibiotic Prescribing in Primary Health Care: Systematic Review

Cited by 61 publications

References 27 publications

Investigating the impact of COVID-19 on primary care antibiotic prescribing in North West London across two epidemic waves

Investigating the impact of COVID-19 on primary care antibiotic prescribing in North West London across two epidemic waves

Impact of the COVID-19 Pandemic on Antibiotic Prescribing for Common Infections in The Netherlands: A Primary Care-Based Observational Cohort Study

Implications of COVID-19 Pandemic on the Emergence of Antimicrobial Resistance: Adjusting the Response to Future Outbreaks

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