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

Abstract

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.

Marked Reductions in Pediatric Outpatient Antibiotic Prescribing in Portugal During the Pandemic

“…While some similar ndings have been reported in recent studies from Scotland 6 , England 7 and the Netherlands 8 , that also found a reduction in both incidence of infectious diseases and antibiotic consumption in the general population, particularly in respiratory-tract infections and prescription of penicillins, our study, limited to children and adolescents, adds more detail about different pediatric age groups and covers a longer period of time that spans 2 lockdowns and intervening non-lockdown period during the pandemic. It evaluates data on ambulatory prescribing by GPs and hospital emergency services in a country which, in contrast to those which have previously reported, is in the "middle band' for usage of antibiotics, and shows comparable decreases to those seen in these "low-use" countries.…”

“…[1][2][3][4] A sudden decrease in presentations of other pediatric infectious diseases was reported [1][2][3], and a reduction in antibiotic consumption in the general population was observed in some settings. [5][6][7] Inappropriate and widespread use of antibiotics is established as a main cause of emergence of resistant strains [8], with antimicrobial resistance (AMR) being recognized as a global public health threat.…”

Impact of the COVID-19 Pandemic on the Prescribing Patterns of First-Line Antibiotics in English Primary Care: A Longitudinal Analysis of National Prescribing Dataset

“…Our findings are in line with the findings of other international studies. Studies from the Netherlands [ 10 ] and the USA [ 11 , 12 ] have reported a decrease in presentation of infections and antibiotic prescribing in 2020 compared to previous year(s). However, the Dutch study [ 10 ] reported the highest decline in prescriptions for gastrointestinal infection, in contrast with the findings of our study that reported the highest decline for upper respiratory tract prescriptions.…”

“…Studies from the Netherlands [ 10 ] and the USA [ 11 , 12 ] have reported a decrease in presentation of infections and antibiotic prescribing in 2020 compared to previous year(s). However, the Dutch study [ 10 ] reported the highest decline in prescriptions for gastrointestinal infection, in contrast with the findings of our study that reported the highest decline for upper respiratory tract prescriptions. Data from the USA reported the highest reduction in antibiotic prescribing in the outpatient setting in April (–39%) and May (–42%) 2020 compared to antibiotic prescribing in 2017–2019 [ 12 ].…”

“…However, there is currently limited empirical evidence to document the actual impact of COVID-19-related restrictions on prescribing of antibiotics. An observational study from the Netherlands reported a reduction in the presentation of bacterial infections and antibiotic prescribing in primary care [ 10 ]. This study was designed to further build on existing evidence and aimed to assess the impact of COVID-19-related restrictions on antibiotic prescribing patterns and costs in English primary care.…”