Infectious Disease

Outpatient antibiotic prescribing down significantly in 2020

March 13, 2023

2 min read

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Disclosures:
The authors report no relevant financial disclosures.

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Key takeaways:

  • Overall outpatient antibiotic prescribing fell 26.8% in 2020.
  • Face masks and school closures were associated with fewer antibiotic prescriptions among children, suggesting NPIs may have contributed to reductions of other upper respiratory infections.

Outpatient antibiotic prescribing fell more than 25% in 2020 compared with earlier years across all ages, but researchers found most of the prescribing was among adults, according to a study published in Open Forum Infectious Diseases.

“Inappropriate prescribing of antibiotics for viral upper respiratory infections was common pre-pandemic, and we wanted to see if data indicated increases in COVID-19 cases, often presenting with upper respiratory symptoms, were associated with increases in outpatient antibiotic prescribing,” Alisa Hamilton, MSsenior research analyst at the One Health Trust, told Healio.

IDN0323Hamilton_Graphic_01_WEB

Hamilton A, et al. Open Forum InfectDis. 2023;doi:10.1093/ofid/ofad096.

“We were also curious about the impact of nonpharmaceutical interventions (NPIs) on prescribing. Prevention measures, such as wearing masks and closing schools, could have reduced transmission of other upper respiratory infections, which, in turn, could have led to reductions in prescribing,” Hamilton said.

To assess the overall impact of COVID-19 cases on antibiotic prescribing, Hamilton and colleagues conducted an ecological study using random effects panel regression of monthly reported COVID-19 county case and antibiotic prescription data. According to the study, they evaluated for seasonality, urbanicity, health care access NPIs, and sociodemographic factors.

Total outpatient antibiotic prescribing fell 26.8% between March and December 2020 compared with the same period in recent years. Trends in prescribing showed that prescriptions fell “significantly” between April and May 2020, rebounded in June and July, and remained below average through the rest of the year.

When assessing specific antibiotics, the study showed that overall prescribing of Quinolones dropped 28.9% from a mean of 6,738.3 prescriptions per 100,000 in previous years to 4,787.1 per 100,000 in 2020, whereas tetracyclines dropped 3.13% and other antibiotics showed “negligible changes.”

When assessed at a county level, the researchers found that each 1% increase in COVID-19 cases was associated with a 0.009% (95% CI, 0.007%-0.012%) increase in prescriptions per 100,000 population dispensed to all ages and a 0.012 % (95% CI, -0.017% to -0.008%) decrease in prescriptions per 100,000 children.

Further subanalyses assessing children specifically showed that counties with schools conducting in-person learning were associated with a 0.044% (95% CI, 0.024%-0.065%) increase in prescriptions per 100,000 children compared with counties that closed schools.

The researchers also found other factors associated with lower prescribing among children, including “internal movement restrictions” and school closures (–0.03%; 95% CI, –0.047% to –0.013%) and requiring face masks (0.029%; 95% CI , –0.054% to –0.004%).

“We can learn a lot from historical COVID-19 data when it comes to antibiotic prescribing, which can help in planning for seasonal epidemics and designing antimicrobial stewardship programs,” Hamilton said. “Given that prescribing norms appear to cluster at the state level, considering cultural differences and tailoring antimicrobial stewardship programs to local contexts are likely key components in their success.”

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