Antibiotic Utilization during COVID-19: Are We Over-Prescribing?

Area of Science:

• Pharmacology and Public Health
• Infectious Disease Epidemiology
• Antimicrobial Stewardship

Background:

• The COVID-19 pandemic led to increased antibiotic prescribing in outpatient settings.
• Understanding pre-pandemic and pandemic-era antibiotic utilization is crucial for antimicrobial stewardship.
• The Republic of Srpska provides a specific context for analyzing these trends.

Purpose of the Study:

• To analyze outpatient antibiotic utilization before and during the COVID-19 pandemic (2018-2020).
• To examine antibiotic prescribing practices for COVID-19 outpatients from 2020 to 2022.
• To assess the impact of the pandemic on antibiotic use patterns.

Main Methods:

• Utilized the Anatomical Therapeutic Chemical Classification/Defined Daily Dose (ATC/DDD) methodology.
• Analyzed outpatient antibiotic utilization data (DDD/1000 inhabitants/day).
• Reviewed medical records of 16,565 COVID-19 outpatients (ICD-10 codes B34.2, U07.1, U07.2).

Main Results:

• Outpatient antibiotic utilization increased by 53.80% in 2020 compared to 2019.
• Antibiotics were prescribed to 91.04% (2020), 83.05% (2021), and 73.52% (first half of 2022) of COVID-19 outpatients.
• Azithromycin, amoxicillin/clavulanic acid, and doxycycline were the most frequently prescribed antibiotics.

Conclusions:

• The COVID-19 pandemic significantly increased outpatient antibiotic prescribing.
• High rates of antibiotic prescription for COVID-19 patients raise concerns about antimicrobial resistance.
• The repurposing of antibiotics may lead to a loss of effectiveness and increased resistance.