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Antimicrobial stewardship in the UK during the COVID-19 pandemic: a population-based cohort study and interrupted

Emma Rezel-Potts1, Veline L'Esperance2, Martin C Gulliford3

  • 1School of Population Health and Environmental Sciences, King's College London, London; National Institute for Health Research Biomedical Research Centre (BRC), Guy's and St Thomas' NHS Foundation Trust, London.

The British Journal of General Practice : the Journal of the Royal College of General Practitioners
|March 10, 2021
PubMed

Insights

The COVID-19 pandemic initially increased antibiotic prescribing, then decreased it below expected levels during lockdown. This suggests antimicrobial stewardship priorities were maintained despite the pandemic.

Area of Science:

  • Public Health
  • Infectious Disease Epidemiology
  • Antimicrobial Stewardship

Background:

  • The COVID-19 pandemic significantly impacted healthcare delivery and practices, including antimicrobial stewardship in primary care.
  • Understanding these changes is crucial for maintaining effective infection control strategies.

Purpose of the Study:

  • To evaluate the effect of the COVID-19 pandemic on antibiotic prescribing patterns.
  • To analyze changes in consultations for respiratory tract infections (RTIs) and urinary tract infections (UTIs) during the pandemic.

Main Methods:

  • A population-based cohort study utilized the UK Clinical Practice Research Datalink (CPRD) GOLD database (January 2017–September 2020).
  • Interrupted time-series analysis assessed antibiotic prescribing and RTI/UTI consultation trends, adjusting for covariates.
  • The proportion of COVID-19 episodes associated with antibiotic prescribing was also examined.

Main Results:

  • March 2020 saw increased antibiotic prescribing (ARR 1.13), followed by a significant decrease below predicted rates from April to August 2020 (minimum ARR 0.73 in May).
  • Pandemic months showed reduced RTI/UTI consultations (RTI ARR 0.23 in April).
  • A small decrease in antibiotic prescribing for RTIs and no change for UTIs were observed; 11% of COVID-19 patients received antibiotics.

Conclusions:

  • Initial increases in antibiotic prescribing during the pandemic were followed by decreases below expected levels during lockdown.
  • These findings are reassuring regarding the continued focus on antimicrobial stewardship despite COVID-19.
  • Further research is needed on the impact of reduced RTI/UTI consultations on serious bacterial infection incidence.
Abstract

Keywords:
COVID-19SARS-CoV-2antibiotic prescribingantimicrobial stewardshiprespiratory tract infectionsurinary tract infections

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