Time series analysis of the incidence of acute upper respiratory tract infections, COVID-19 and the use of antibiotics in Finland during the COVID-19 epidemic: a cohort study of 833 444 patients

Niemenoja, Oskar; Taalas, Ara; Taimela, Simo; Bono, Petri; Huovinen, Pentti; Riihijärvi, Sari

doi:10.1136/bmjopen-2020-046490

Cited by 8 publications

(8 citation statements)

References 11 publications

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“…In the United Kingdom, antibiotic prescribing rates in primary care were higher at the start of the pandemic (March 2020), but fell below expected rates between April and August 2020 [ 2 ]. Similar decreases in outpatient antibiotic prescriptions since the start of the pandemic have been found in Finland [ 3 ], the Netherlands [ 4 ], Spain [ 5 ], and Canada [ 6 ].…”

Section: Introductionsupporting

confidence: 64%

“…A decrease in antibiotic prescription rates in the community following the start of the COVID-19 pandemic has been described previously on an international level [ 2 , 3 , 4 , 5 , 13 ], and within Canada [ 6 ]. Our results are similar to those of Knight et al, who found that in the outpatient setting in Canada, antibiotics mainly used for RTIs were prescribed at a much lower rate in the early months of the COVID-19 pandemic, which did not recover later on [ 6 ].…”

Section: Discussionmentioning

confidence: 76%

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A Time Series Analysis Evaluating Antibiotic Prescription Rates in Long-Term Care during the COVID-19 Pandemic in Alberta and Ontario, Canada

et al. 2022

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The COVID-19 pandemic affected access to care, and the associated public health measures influenced the transmission of other infectious diseases. The pandemic has dramatically changed antibiotic prescribing in the community. We aimed to determine the impact of the COVID-19 pandemic and the resulting control measures on oral antibiotic prescribing in long-term care facilities (LTCFs) in Alberta and Ontario, Canada using linked administrative data. Antibiotic prescription data were collected for LTCF residents 65 years and older in Alberta and Ontario from 1 January 2017 until 31 December 2020. Weekly prescription rates per 1000 residents, stratified by age, sex, antibiotic class, and selected individual agents, were calculated. Interrupted time series analyses using SARIMA models were performed to test for changes in antibiotic prescription rates after the start of the pandemic (1 March 2020). The average annual cohort size was 18,489 for Alberta and 96,614 for Ontario. A significant decrease in overall weekly prescription rates after the start of the pandemic compared to pre-pandemic was found in Alberta, but not in Ontario. Furthermore, a significant decrease in prescription rates was observed for antibiotics mainly used to treat respiratory tract infections: amoxicillin in both provinces (Alberta: −0.6 per 1000 LTCF residents decrease in weekly prescription rate, p = 0.006; Ontario: −0.8, p < 0.001); and doxycycline (−0.2, p = 0.005) and penicillin (−0.04, p = 0.014) in Ontario. In Ontario, azithromycin was prescribed at a significantly higher rate after the start of the pandemic (0.7 per 1000 LTCF residents increase in weekly prescription rate, p = 0.011). A decrease in prescription rates for antibiotics that are largely used to treat respiratory tract infections is in keeping with the lower observed rates for respiratory infections resulting from pandemic control measures. The results should be considered in the contexts of different LTCF systems and provincial public health responses to the pandemic.

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Section: Introductionsupporting

confidence: 64%

Section: Discussionmentioning

confidence: 76%

A Time Series Analysis Evaluating Antibiotic Prescription Rates in Long-Term Care during the COVID-19 Pandemic in Alberta and Ontario, Canada

et al. 2022

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“…In addition, lower incidences of in uenza during the pandemic were reported in Israel and other countries compared to previous years [14,15]. The clinical signi cance of these ndings is corroborated by decreases in Israeli emergency department visits for URTI in 2020 compared to the preceding years [16] and a sharp decline in antibiotic prescriptions in Finland during the pandemic [17]. In our cohort, we demonstrate a reduction in URTI diagnoses by GPs in both males and females and across all age groups for adults, which is in line with previous ndings [14,16].…”

Section: Duration Of Sick Leavementioning

confidence: 88%

Dynamics of upper respiratory tract infections before, during, and after the COVID-19 pandemic in Germany: a cross-sectional study of 2,167,453 outpatients

Loosen

Plendl

Konrad

et al. 2023

Preprint

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Background Although the burden of the COVID-19 pandemic on global healthcare systems is declining, long-term sequelae such as long COVID syndrome and other disease dynamics not primarily associated with COVID-19 remain a challenge. Recent data suggest that the incidence of non-COVID upper respiratory tract infections (URTI) is increasing sharply in the post-pandemic period, but there is a lack of real-world data from Germany in this respect. Methods This cross-sectional study evaluated the number of patients with a diagnosis of URTI from the Disease Analyzer database (IQVIA) between January 2019 and December 2022. The number of UTRI diagnoses per practice and the duration of sick leave per patient were compared over time. Results A total of 1,872,935 individuals (1,403,907 patients from general practices (GP) and 469,028 patients from pediatric offices) were included, 48% of whom were female. The number of URTI patients per practice was significantly higher in 2022 than in 2019 (732 vs. 464, 58%, p < 0.001) and this was observed for both women (56%, p < 0.001) and men (60%, p < 0.001). The post-pandemic increase in the number of URTI diagnoses correlated with age and was highest in the age group between 18–30 years (22%, p < 0.001) and lowest in older patients > 70 years (3%). In pediatric patients (< 18 years), the increase was highest in the age group ≤ 5 years (89%). Both the number of patients per practice on sick leave due to URTI (184 vs. 92) and the average duration of sick leave (+ 2 days) increased from 2019 to 2022. Conclusion Our data suggest a dramatic increase in the incidence of URTI among all demographic subgroups in Germany between 2019 and 2022, which was associated with a tremendous impact on socioeconomic variables such as the frequency or duration of sick leave. These data could be of great importance in current pandemic management and the management of future pandemics.

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“…The present study was carried out before the COVID-19 pandemic, which had drastic effects [ 24 ] on the use of antibiotics due to several infection control orders in Finnish society. The short-term effect of the COVID-19 pandemic on antibiotic use in Finland has been studied elsewhere [ 25 ]. With this background, we set up the present nationwide work to study the use of antibiotics by age and sex among the total adult outpatient Finnish population from 2008–2019, and also the cost of antibiotics.…”

Section: Introductionmentioning

confidence: 99%

Outpatient Antibiotic Use and Costs in Adults: A Nationwide Register-Based Study in Finland 2008–2019

et al. 2022

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The objective of this study was to describe the prevalence of outpatient use and costs for systemic antibacterials by age and sex among adults in Finland from 2008–2019. Data from the Finnish statistical database Kelasto, containing information concerning all reimbursed medicines for 18+-year-olds during 2008–2019, were analyzed. In addition to the decreased (26%) use of systemic antibiotics, decreased use was observed in all antibiotic categories, notably including several wide-spectrum antibiotics. The use of quinolones decreased by 49% and of tetracyclines by 39%. The 10 most frequently used antibiotics covered 89% of all adult antibiotic prescriptions. Antibiotic use also decreased in every age group during the study period. Although the overall yearly costs of outpatient antibiotics during the 10-year study period decreased from EUR 36.4 million to EUR 30.7 million, the cost per prescription increased slightly. In conclusion, according to the findings of this study, concerning adults and the results of our previous study concerning children and adolescents (2008–2016), there has been a decreasing trend of outpatient antibacterial use among the whole Finnish outpatient population over the duration of nearly one decade. However, during the same time period, there has been a specific increasing trend for the Gram-negative AMR threat regarding E. coli resistance. Therefore, based on our important findings in Finland, methods other than the restriction of antibiotic use, such as new anti-infective innovations, including antibacterials, are needed as soon as possible to tackle this major global health threat—a silent pandemic.

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Time series analysis of the incidence of acute upper respiratory tract infections, COVID-19 and the use of antibiotics in Finland during the COVID-19 epidemic: a cohort study of 833 444 patients

Cited by 8 publications

References 11 publications

A Time Series Analysis Evaluating Antibiotic Prescription Rates in Long-Term Care during the COVID-19 Pandemic in Alberta and Ontario, Canada

A Time Series Analysis Evaluating Antibiotic Prescription Rates in Long-Term Care during the COVID-19 Pandemic in Alberta and Ontario, Canada

Dynamics of upper respiratory tract infections before, during, and after the COVID-19 pandemic in Germany: a cross-sectional study of 2,167,453 outpatients

Outpatient Antibiotic Use and Costs in Adults: A Nationwide Register-Based Study in Finland 2008–2019

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