Impact of the COVID-19 Outbreak on the Antibiotic Use Patterns among a Rural Community Population in Eastern China

Abstract

There are growing concerns that the coronavirus disease of 2019 (COVID-19) pandemic may change antibiotic use patterns and accelerate antibiotic resistance, but evidence from the community level is lacking. This study aims to estimate the impact of the COVID-19 outbreak on the antibiotic use patterns among a community population in Eastern China. A self-administered medicine diary was used to collect information on antibiotic use from July 2019 to June 2021 among a rural community in Eastern China. We analyzed the changes in antibiotic use patterns over five months from August to December 2019 and the corresponding months in 2020. The risk of antibiotic use and its changes were measured with the incidence rate (IR) and relative risk (RR). In total, 1111 participants were eligible for the final analysis (440 in 2019 and 671 in 2020). After the COVID-19 outbreak, antibiotic use increased by 137% (5.43 per 100 person months in the 2019 vs. 12.89 per 100 person months in the 2020), and after the adjustment of covariates, the adjusted RR was 1.72 (95% CI: 1.10~2.34). It was higher among those who were women (RR = 2.62), aged 35–59 years old (RR = 2.72), non-farmers (RR = 2.75), had less than six years of education (RR = 2.61), had an annual household income over CNY 100,000 (USD 14,940) (RR = 2.60), and had no history of chronic diseases (RR = 2.61) (all p < 0.05). The proportion of cephalosporins consumed increased from 54.29% in 2019 to 64.92% in 2020 (p = 0.011). Among those aged 35 years and older, the proportion of antibiotics obtained from medical facilities increased, while the proportion obtained from retail pharmacies, homes, and other sources decreased (all p < 0.05). The COVID-19 outbreak changed antibiotic use patterns in this study population (Eastern China) significantly. More efforts to monitor and enhance antibiotic stewardship activities at the community level are needed in future.

Regional and National Trends in Consumption of Antimicrobials in Pakistan; Pre and Post-COVID (2019–2021)

“…Pakistan has one of the highest burdens of infectious diseases in the world [ 13 , 14 , 24 ]. To make matters worse, growing economic and financial fragility in the aftermath of the COVID-19 pandemic, combined with rapidly changing climate and natural disasters, put Pakistan at high risk of a national health crisis brought on by infectious diseases [ 25 ].…”

Multiple impacts of the COVID-19 pandemic and antimicrobial stewardship on antimicrobial resistance in nosocomial infections: an interrupted time series analysis

“…For instance, a higher HAI rate was reported in Nanjing, China in 2020 ( 14 ). A similar study found that during the COVID-19 epidemic, antibiotic use increased by 137% and antibiotic use patterns significantly changed among a rural community in Eastern China ( 15 ). However, the analysis of nationwide procurement data revealed a different result that antibiotic-defined daily doses per 1,000 inhabitants per day dropped in 2020 ( 16 ).…”

The emerging antimicrobial resistance crisis during the COVID-19 surge in China

“…China also tightened drug selling to treat COVID-19-related symptoms as part of its zero-COVID efforts, which contributed to lessened self-medication with antibiotics. 3 Therefore, antimicrobial resistance has not been seen as an urgent issue, at least until China relaxed its zero-COVID policy in early December, 2022. The current surge of SARS-CoV-2 infections across China will lead to an increase in the use of antibiotics, which will exacerbate the irrational use of antibiotics seen before the COVID-19 era.…”