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. 2023 Mar:57:101848.
doi: 10.1016/j.eclinm.2023.101848. Epub 2023 Feb 6.

Global antibiotic use during the COVID-19 pandemic: analysis of pharmaceutical sales data from 71 countries, 2020-2022

Arindam Nandi  1   2 , Simone Pecetta  3 , David E Bloom  4
Affiliations

Global antibiotic use during the COVID-19 pandemic: analysis of pharmaceutical sales data from 71 countries, 2020-2022

Arindam Nandi et al. EClinicalMedicine. 2023 Mar.

Abstract

Background: Despite bacterial coinfection rates of less than 10%, antibiotics are prescribed to an estimated 75% of patients with COVID-19, potentially exacerbating antimicrobial resistance. We estimated the associations of COVID-19 cases and vaccinations with global antibiotic sales during the first two years of the COVID-19 pandemic.

Methods: We obtained monthly data on broad-spectrum antibiotic sales volumes (cephalosporins, penicillins, macrolides, and tetracyclines) in 71 countries during March 2020-May 2022 from the IQVIA MIDAS® database. These data were combined with country-month-level COVID-19 case and vaccination data from Our World in Data. We used least squares (pooled) and fixed-effects panel data regression models, accounting for country characteristics, to estimate the associations between antibiotic sales volumes and COVID-19 cases and vaccinations per 1000 people.

Findings: Sales of all four antibiotics fell sharply during April and May 2020, followed by a gradual rise to near pre-pandemic levels through May 2022. In fixed-effects regression models, a 10% increase in monthly COVID-19 cases was associated with 0.2%-0.3% higher sales of cephalosporins, 0.2%-0.3% higher sales of penicillins, 0.4%-0.6% higher sales of macrolides, and 0.3% higher sales of all four antibiotics combined per 1000 people. Across continents, a 10% increase in monthly COVID-19 cases was associated with 0.8%, 1.3%, and 1.5% higher macrolides sales in Europe, North America, and Africa respectively. Sales of other antibiotics across continent were also positively associated with COVID-19 cases, although the estimated associations were smaller in magnitude. No consistent associations were observed between antibiotic sales and COVID-19 vaccinations. Results from pooled regression analysis were similar to those from the fixed-effects models.

Interpretation: Antibiotic sales were positively associated with COVID-19 cases globally during 2020-2022. Our findings underline that antibiotic stewardship in the context of COVID-19 remains essential.

Funding: Bill & Melinda Gates Foundation.

Keywords: AMR; Antibiotic use; Antimicrobial resistance; COVID-19.

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Conflict of interest statement

SP was an employee of the GlaxoSmithKline group of companies when this research was conducted, and is currently an employee of Moderna Inc. DB has previously received research support or personal fees from 10.13039/100004330GlaxoSmithKline plc, 10.13039/100004334Merck, 10.13039/100004319Pfizer, and Sanofi-Pasteur related to value-of-vaccination research, but not for this study. AN received travel support from 10.13039/100004330GlaxoSmithKline plc for attending a conference related to the work presented in this manuscript.

Figures

Fig. 1
Fig. 1
COVID-19 cases and oral broad-spectrum antibiotic use in 71 countries, January 2018–May 2022. Note: Data are monthly global (71 countries) averages, obtained from IQVIA MIDAS and Our World in Data.
See this image and copyright information in PMC

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