The Impact of the COVID-19 Pandemic on Antibiotic Prescribing Trends in Outpatient Care: A Nationwide, Quasi-Experimental Approach

Abstract

Coronavirus disease 2019 (COVID-19) has spread globally and is currently having a damaging impact on nearly all countries in the world. The implementation of stringent measures to stop COVID-19 dissemination had an influence on healthcare services and associated procedures, possibly causing antibiotic consumption fluctuations. This paper aims to evaluate the immediate and long-term impact of the COVID-19 pandemic on antibiotic prescribing trends in outpatient care of the Portuguese public health sector, including in primary healthcare centers and hospitals, as well as on specific antibiotic groups known to be closely associated with increased resistance. Segmented regression analysis with interrupted time series data was used to analyze whether the COVID-19 pandemic had an impact in antibiotic prescribing tendencies at a national level. The outcomes from this quasi-experimental approach demonstrate that, at the beginning of the pandemic, a significant, immediate decrease in the overall antibiotic prescribing trends was noticed in the context of outpatient care in Portugal, followed by a statistically non-significant fall over the long term. The data also showed a significant reduction in the prescription of particular antibiotic classes (antibiotics from the Watch group, 3rd-generation cephalosporins, fluoroquinolones, and clarithromycin) upon COVID-19 emergence. These findings revealed an important disruption in antibiotics prescribing caused by the current public health emergency.

Consumo de antibióticos en atención primaria en población adulta de Asturias durante el periodo 2014-2020

“…Esta tendencia se detecta en otros países, como Reino Unido o Portugal 18 , 19 , con un sistema sanitario parecido al nuestro y en otros continentes 20 , 21 , 22 . En un estudio del ámbito de AP 18 , la prescripción se redujo un 15,48% en el periodo de abril a agosto de 2020 respecto al mismo periodo de 2019, aunque, teniendo en cuenta el descenso experimentado en el número de consultas, consideran que el número de prescripciones fue un 6,71% mayor que el esperado.…”

“…Además, esa reducción influye de forma importante en la evolución de la tasa de consumo anual durante 2014-2020. Este comportamiento del consumo de antibióticos en el periodo de pandemia se describe también en estudios de otros países 18 , 19 , 20 , 21 , 22 , y puede tener relación con cambios cuantitativos y cualitativos en la accesibilidad, en el perfil epidemiológico de las infecciones respiratorias, y en la propia práctica profesional.…”

Evaluation of Antibacterial and Antiviral Drug Effectiveness in COVID-19 Therapy: A Data-Driven Retrospective Approach

“…Importantly, this may lead to higher resistance potential. Antibiotic selection pressure [ 34 , 35 ] would increase the incidence of multidrug-resistant organisms. Thirteen bacteria have been identified as causing a secondary infection to SARS-CoV-2, where it may lead to increased mortality and morbidity for COVID-19 patients [ 36 ].…”

Impact of the COVID-19 Pandemic on Community Antibiotic Prescribing and Stewardship: A Qualitative Interview Study with General Practitioners in England

“…Studies from primary care in England have shown an overall decrease in antibiotic prescribing during 2020 compared to pre-pandemic [18][19][20][21][22][23], with similar trends identified in Scotland [24], Northern Ireland [25] and other countries [26][27][28][29]. However, one study on UK data noted an initial increase in antibiotic prescribing in March 2020 before prescribing levels dropped below those expected (with the lowest rate in May) [20].…”