The impact of influenza and pneumococcal vaccination on antibiotic use: an updated systematic review and meta-analysis

Abstract

Background Vaccination can prevent bacterial and viral infections that could otherwise increase the chances of receiving (unnecessary) antibiotic treatment(s). As a result, vaccination may provide an important public health intervention to control antimicrobial resistance (AMR). Objectives Perform a systematic literature review to better understand the impact of influenza, pneumococcal and COVID-19 vaccination on antibiotic use, and to identify differences in effect between world regions and study designs. Methods We performed a systematic literature review and meta-analysis which updated previous literature reviews with new data from 1 October 2018 to 1 December 2021. The study focuses on randomised controlled trials (RCTs) and observational studies. Results from the meta-analysis of RCTs were stratified by WHO region and age group. Vote counting based on the direction of effect was applied to synthesize the results of the observational studies. Results Most studies are performed in the WHO European Region and the Region of the Americas in high-income countries. RCTs show that the effect of influenza vaccination on the number of antibiotic prescriptions or days of antibiotic use (Ratio of Means (RoM) 0.71, 95% CI 0.62–0.83) is stronger compared to the effect of pneumococcal vaccination (RoM 0.92, 95% CI 0.85–1.00). These studies also confirm a reduction in the proportion of people receiving antibiotics after influenza vaccination (Risk Ratio (RR) 0.63, 95% CI 0.51–0.79). The effect of influenza vaccination in the European and American regions ranged from RoM 0.63 and 0.87 to RR 0.70 and 0.66, respectively. The evidence from observational studies supports these findings but presents a less consistent picture. No COVID-19 studies were identified. Conclusion We find that both RCTs and observational studies show that influenza vaccination significantly reduces antibiotic use, while the effect of pneumococcal vaccination is less pronounced. We were unable to study the effect of COVID-19 vaccination and no clear regional patterns were found due to the high heterogeneity between studies. Overall, our data supports the use of influenza vaccination as an important public health intervention to reduce antibiotic use and possibly control AMR.

Echinacea Reduces Antibiotics by Preventing Respiratory Infections: A Meta-Analysis (ERA-PRIMA)

“…Along with results on RTI incidence and duration, no previous meta-analyses investigated the sequence of incident RTI, RTI recurrences, RTI complications and the use of antibiotics, therefore no comparative effects are available. The strategy to reduce antibiotic use through RTI prevention is very promising and has been described similarly for influenza and pneumococcal vaccines, which are associated with a 10-40% reduction of antibiotic prescriptions or antibiotic days [54]. This effect has now been demonstrated to be applicable to Echinacea as well, while results shown for alcoholic fresh-plant Echinacea extracts (55-70%, Appendix A, Table A4) seem to exceed the effectiveness of the aforementioned vaccinations.…”

Efficacy and Safety of Vaccinations in Geriatric Patients: A Literature Review

“…These studies also confirm a reduction in the percentage of people receiving antibiotics after influenza vaccination (hazard ratio (RR) 0.63, 95% CI 0.51–0.79). The effect of influenza vaccination in the European and American regions ranged from RoM 0.63 and 0.87 to RR 0.70 and 0.66, respectively [ 98 ]. As we have already observed, the excessive consumption of antibiotics is often linked to incongruous prescriptions both by etiology (the symptoms are often largely due to viral infections), molecule (the choice of the active ingredient is often not targeted and its non-quantifiable therapeutic effect), the dosage used (most antibiotics are not used in therapeutic doses), and finally by administration times, which are not always compliant with existing guidelines [ 84 , 99 ].…”