Association of Changes in Seasonal Respiratory Virus Activity and Ambulatory Antibiotic Prescriptions With the COVID-19 Pandemic

Abstract

This pre-post study examines the association between respiratory virus incidence and ambulatory antibiotic orders and the COVID-19 pandemic.

Figure 1.. Respiratory Virus Testing Results From July 2018 Through February 2021

The total number of polymerase chain reaction–positive respiratory virus test results by week are shown by stacked boxes. Data are from the State of Wisconsin Respiratory Virus Surveillance Program. The blue line represents the total testing volume on a weekly basis. The gray background indicates the COVID-19 pandemic period. hMPV indicates human metapneumovirus; PIV, human parainfluenza virus; RSV, respiratory syncytial virus; sCoV, seasonal coronavirus.

Figure 2.. Ambulatory Antibiotic Prescribing Rates July 2018 Through February 2021

Antibiotic prescriptions were normalized by the number of patient encounters. Indication was captured using a required order form element within the electronic health record. A, Ambulatory antibiotic prescribing rates for all indications (orange), non–respiratory tract infection (RTI) indications (eg, urinary tract infection; black), and RTI indications (dark gray). Circles indicate the prepandemic period, and the triangles and blue background indicate the COVID-19 pandemic period. The dotted line denotes the onset of the COVID-19 pandemic. B, Ambulatory antibiotic prescription rates (95% CI) for RTI during the pre-COVID-19 and COVID-19 pandemic periods, adjusted for seasonality. C, Ambulatory antibiotic prescription rates for RTI by month stratified by prepandemic period (circles) and pandemic period (triangles). Individual points denote observed prescription rates. The black line represents the generalized additive model prediction (shaded area, 95% CI) for antibiotic prescriptions for RTI adjusted for seasonality.