Impact of the COVID-19 pandemic on community antibiotic prescribing and stewardship: a qualitative interview study with general practitioners in England

Abstract

The COVID-19 pandemic has had a profound impact on the delivery of primary care services. We aimed to identify general practitioners’ (GPs’) perceptions and experiences of how the COVID-19 pandemic influenced antibiotic prescribing and antimicrobial stewardship (AMS) in general practice in England. Twenty-four semi-structured interviews were conducted with 18 GPs at two time-points: autumn 2020 (14 interviews) and spring 2021 (10 interviews). Interviews were audio-recorded, transcribed and analysed thematically, taking a longitudinal approach. Participants reported a lower threshold for antibiotic prescribing (and fewer consultations) for respiratory infections and COVID-19 symptoms early in the pandemic, then returning to more usual (pre-pandemic) prescribing. They perceived less impact on antibiotic prescribing for urinary and skin infections. Participants perceived the changing ways of working and consulting (e.g., proportions of remote and in-person consultations), and the changing patient presentations and GP workload as influencing the fluctuations in antibiotic prescribing. This was compounded by decreased engagement with, and priority of, AMS due to COVID-19-related urgent priorities. Re-engagement with AMS is needed, e.g., through reviving antibiotic prescribing feedback and targets/incentives. While the pandemic disrupted the usual ways of working, it also produced opportunities, e.g., for re-organising ways of managing infections and AMS in the future.

Serologic response and safety of COVID-19 vaccination in HSCT or CAR T-cell recipients: a systematic review and meta-analysis

“…Once infected with SARS-CoV-2, they are prone to developing severe or fatal symptoms, associated with higher rates of hospitalization and mortality [ 18 , 19 ]. On this basis, the European and US transplant guidelines consider that the benefits of COVID-19 vaccination may overweigh risks for patients receiving HSCT or CAR T-cell and recommend COVID-19 vaccination as early as three months after transplantation or cell therapy [ 20 , 21 ]. These recommendations were based on limited evidence from individual studies on COVID-19 vaccines with small sample size and previous clinical experience with infections caused by other pathogens.…”

Antibiotic use in township hospitals during the COVID-19 pandemic in Shandong, China

“…The Coronavirus Disease-19 (COVID-19) pandemic swept across the world quickly and placed a heavy burden on the health systems globally. The impacts of the COVID-19 pandemic on antibiotic consumption and the risk of AMR have aroused the attention of many researchers of antibiotic resistance [11][12][13][14][15][16][17][18][19]. A report stated that after the outbreak of the COVID-19 pandemic in most European countries, the total consumption of antibiotics declined by more than 15%, which was mainly observed in PHSs [13].…”

“…Several national studies conducted in the USA, Portugal, Canada, and the UK also showed that a signi cant decrease was observed in the overall antibiotic consumption by outpatients or in broadspectrum antibiotic prescriptions during the COVID-19 pandemic; especially, the number of prescriptions of certain categories of antibacterials (e.g., third-generation cephalosporins, uoroquinolones) decreased signi cantly [11,12,[14][15][16]. In China, a few similar studies also found that there was a decline in consumption of antibiotics during the .…”

“…Therefore, it is necessary to optimize antibiotic use in PHSs for containing bacterial resistance [4, 6,10].The Coronavirus Disease-19 (COVID-19) pandemic swept across the world quickly and placed a heavy burden on the health systems globally. The impacts of the COVID-19 pandemic on antibiotic consumption and the risk of AMR have aroused the attention of many researchers of antibiotic resistance [11][12][13][14][15][16][17][18][19]. A report stated that after the outbreak of the COVID-19 pandemic in most European countries, the total consumption of antibiotics declined by more than 15%, which was mainly observed in PHSs [13].Several national studies conducted in the USA, Portugal, Canada, and the UK also showed that a signi cant decrease was observed in the overall antibiotic consumption by outpatients or in broadspectrum antibiotic prescriptions during the COVID-19 pandemic; especially, the number of prescriptions of certain categories of antibacterials (e.g., third-generation cephalosporins, uoroquinolones) decreased signi cantly [11,12,[14][15][16].…”

The impact of COVID-19 on antimicrobial stewardship programme implementation in hospitals – an exploration informed by the Consolidated Framework for Implementation Research

“…This rapid reform has also affected ASP activities, where efforts to resume ASP practices have been described through embracing technology to facilitate ASP meetings and rounds, upgrading existing electronic health systems, increasing use of procalcitonin to differentiate between viral and bacterial infection and increased adoption of outpatient parenteral antimicrobial therapy (OPAT) [1,5]. ASP team members have efficiently contributed to the pandemic relief effort through their roles in novel antiviral clinical trials, COVID-19 disease management guideline development, repurposing prospective audit and feedback, formulary restriction and preauthorisation to support COVID-19 patients [2,10].…”