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. 2022 Mar;88(3):1143-1151.
doi: 10.1111/bcp.15000. Epub 2021 Aug 17.

Changes in antibiotic prescribing following COVID-19 restrictions: Lessons for post-pandemic antibiotic stewardship

Malcolm B Gillies  1 , David P Burgner  2   3 , Lorraine Ivancic  4 , Natasha Nassar  4   5 , Jessica E Miller  2   3 , Sheena G Sullivan  6 , Isobel M F Todd  2 , Sallie-Anne Pearson  1 , Andrea L Schaffer  1 , Helga Zoega  1   7
Affiliations

Changes in antibiotic prescribing following COVID-19 restrictions: Lessons for post-pandemic antibiotic stewardship

Malcolm B Gillies et al. Br J Clin Pharmacol. 2022 Mar.

Abstract

Aims: Public health responses to reduce SARS-CoV-2 transmission have profoundly affected the epidemiology and management of other infections. We examined the impact of COVID-19 restrictions on antibiotic dispensing in Australia.

Methods: We used national claims data to investigate antibiotic dispensing trends from November 2015 to October 2020 and whether changes reflected reductions in primary care consultations. We used interrupted time series analysis to quantify changes in monthly antibiotic dispensing and face-to-face and telehealth GP consultations and examined changes by recipient age, pharmacy State and prescriber specialty.

Results: Over the study period, an estimated 19 921 370 people had 125 495 137 antibiotic dispensings, 71% prescribed by GPs. Following COVID-19 restrictions, we observed a sustained 36% (95% CI: 33-40%) reduction in antibiotic dispensings from April 2020. Antibiotics recommended for managing respiratory tract infections showed large reductions (range 51-69%), whereas those recommended for non-respiratory infections were unchanged. Dispensings prescribed by GPs decreased from 63.5 per 1000 population for April-October 2019 to 37.0 per 1000 for April-October 2020. Total GP consultation rates remained stable, but from April 2020, 31% of consultations were telehealth.

Conclusion: In a setting with a low COVID-19 incidence, restrictions were associated with a substantial reduction in community dispensings of antibiotics primarily used to treat respiratory infections, coincident with reported reductions in respiratory viral infections. Our findings are informative for post-pandemic antimicrobial stewardship and highlight the potential to reduce inappropriate prescribing by GPs and specialists for respiratory viral infections.

Keywords: Australia; COVID-19; antibiotics; epidemiology; physical distancing.

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Conflict of interest statement

H.Z., A.L.S., M.B.G. and S.A.P. are employed by the Centre for Big Data Research in Health, UNSW Sydney, which received funding in 2020 from AbbVie Australia to conduct research, unrelated to this study. The remaining authors report no actual, potential or perceived conflict of interest regarding the submission of this manuscript.

Figures

FIGURE 1
FIGURE 1
Observed and predicted trends in monthly rate of antibiotic dispensings per 1000 Australian population, superimposed with the monthly rate of reimbursements for GP consultations (combined face‐to‐face and telehealth) per 1000 Australian population. Note: Predicted line is deseasonalised. Vertical guideline marks the data for March 2020
FIGURE 2
FIGURE 2
Observed trends in monthly rate of antibiotic dispensings per 1000 Australian population, stratified by prescriber specialty. Note: Vertical guideline marks the data for March 2020
FIGURE 3
FIGURE 3
Observed trends in monthly rate of antibiotic dispensings per 1000 Australian population, stratified by age on the day of dispensing. Note: Vertical guideline marks the data for March 2020
FIGURE 4
FIGURE 4
Observed trend in monthly rate of antibiotic dispensings per 100 GP consultations (combined face‐to‐face and telehealth). Note: Original prescriptions written by a GP only. Vertical guideline marks the data for March 2020
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