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

doi:10.3390/antibiotics12020308

. 2023 Feb 2;12(2):308.

doi: 10.3390/antibiotics12020308.

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

Nataša Bednarčuk¹, Ana Golić Jelić², Svjetlana Stoisavljević Šatara², Nataša Stojaković², Vanda Marković Peković³, Miloš P Stojiljković², Nina Popović⁴, Ranko Škrbić^{2

5}

Affiliations

¹ Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, The Republic of Srpska, Bosnia and Herzegovina.
² Department of Pharmacology, Toxicology and Clinical Pharmacology, Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, The Republic of Srpska, Bosnia and Herzegovina.
³ Department of Pharmacy, Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, The Republic of Srpska, Bosnia and Herzegovina.
⁴ Pharmacies Belladonna, 89101 Trebinje, The Republic of Srpska, Bosnia and Herzegovina.
⁵ Academy of Sciences and Arts of the Republic of Srpska, 78000 Banja Luka, The Republic of Srpska, Bosnia and Herzegovina.

PMID: 36830218
PMCID: PMC9952319
DOI: 10.3390/antibiotics12020308

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

Nataša Bednarčuk et al. Antibiotics (Basel). 2023.

. 2023 Feb 2;12(2):308.

doi: 10.3390/antibiotics12020308.

Authors

Nataša Bednarčuk¹, Ana Golić Jelić², Svjetlana Stoisavljević Šatara², Nataša Stojaković², Vanda Marković Peković³, Miloš P Stojiljković², Nina Popović⁴, Ranko Škrbić^{2

5}

Affiliations

¹ Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, The Republic of Srpska, Bosnia and Herzegovina.
² Department of Pharmacology, Toxicology and Clinical Pharmacology, Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, The Republic of Srpska, Bosnia and Herzegovina.
³ Department of Pharmacy, Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, The Republic of Srpska, Bosnia and Herzegovina.
⁴ Pharmacies Belladonna, 89101 Trebinje, The Republic of Srpska, Bosnia and Herzegovina.
⁵ Academy of Sciences and Arts of the Republic of Srpska, 78000 Banja Luka, The Republic of Srpska, Bosnia and Herzegovina.

PMID: 36830218
PMCID: PMC9952319
DOI: 10.3390/antibiotics12020308

Abstract

The aims of this study were to analyze the utilization of antibiotics before (2018, 2019) and during the COVID-19 pandemic (2020) and the practice of prescribing antibiotics in outpatient settings for COVID-19 patients during the 2020-2022 period. The Anatomical Therapeutic Chemical Classification/Defined Daily Dose methodology was used for the analysis of outpatient antibiotic utilization in the Republic of Srpska. The data was expressed in DDD/1000 inhabitants/day. The rate of antibiotics prescribed to COVID-19 outpatients was analyzed using medical record data from 16,565 patients registered with B34.2, U07.1, and U07.2 World Health Organization International Classification of Diseases 10th revision codes. During 2020, outpatient antibiotic utilization increased by 53.80% compared to 2019. At least one antibiotic was prescribed for 91.04%, 83.05%, and 73.52% of COVID-19 outpatients during 2020, 2021, and the first half of 2022, respectively. On a monthly basis, at least one antibiotic was prescribed for more than 55% of COVID-19 outpatients. The three most commonly prescribed antibiotics were azithromycin, amoxicillin/clavulanic acid, and doxycycline. The trend of repurposing antibiotics for COVID-19 and other diseases treatment might be a double-edged sword. The long-term effect of this practice might be an increase in antimicrobial resistance and a loss of antibiotic effectiveness.

Keywords: COVID-19; antimicrobial resistance; medicine repurposing; outpatient settings; prescribing antibiotics.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

**Figure 1**
The utilization of antibacterial medicines for systemic use (J01 group) during the 2018–2020 period in the Republic of Srpska, at the third level of ATC classification, expressed in DDD/1000 inhabitants/day (DIDs).

**Figure 2**
The percentage of antibiotic prescriptions given to COVID-19 outpatients with WHO ICD-10 codes B34.2, U07.1, and U07.2 during the March 2020–June 2022 period, presented monthly.

**Figure 3**
The relationship between the number of COVID-19 outpatients with B34.2, U07.1, and U07.2 WHO ICD-10 codes and the number of antibiotic prescriptions for COVID-19 outpatients during the March 2020–June 2022 period, presented monthly.

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References

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- NCI CPTC Antibody Characterization Program

[1] Singh T.U., Parida S., Lingaraju M.C., Kesavan M., Kumar D., Singh R.K. Drug repurposing approach to fight COVID-19. Pharmacol. Rep. 2020;72:1479–1508. - PMC - PubMed

[2] Singh T.U., Parida S., Lingaraju M.C., Kesavan M., Kumar D., Singh R.K. Drug repurposing approach to fight COVID-19. Pharmacol. Rep. 2020;72:1479–1508. - PMC - PubMed

[3] Adebisi Y.A., Jimoh N.D., Ogunkola I.O., Uwizeyimana T., Olayemi A.H., Ukor N.A., Lucero-Prisno D.E. The use of antibiotics in COVID-19 management: A rapid review of national treatment guidelines in 10 African countries. Trop. Med. Health. 2021;49:51. doi: 10.1186/s41182-021-00344-w. - DOI - PMC - PubMed

[4] Adebisi Y.A., Jimoh N.D., Ogunkola I.O., Uwizeyimana T., Olayemi A.H., Ukor N.A., Lucero-Prisno D.E. The use of antibiotics in COVID-19 management: A rapid review of national treatment guidelines in 10 African countries. Trop. Med. Health. 2021;49:51. doi: 10.1186/s41182-021-00344-w. - DOI - PMC - PubMed

[5] Lai C.-C., Chen S.-Y., Ko W.-C., Hsueh P.-R. Increased antimicrobial resistance during the COVID-19 pandemic. Int. J. Antimicrob. Agents. 2021;57:106324. doi: 10.1016/j.ijantimicag.2021.106324. - DOI - PMC - PubMed

[6] Lai C.-C., Chen S.-Y., Ko W.-C., Hsueh P.-R. Increased antimicrobial resistance during the COVID-19 pandemic. Int. J. Antimicrob. Agents. 2021;57:106324. doi: 10.1016/j.ijantimicag.2021.106324. - DOI - PMC - PubMed

[7] Van Duin D., Barlow G., Nathwani D. The impact of the COVID-19 pandemic on antimicrobial resistance: A debate. JAC-Antimicrob. Resist. 2020;3:dlaa053. doi: 10.1093/jacamr/dlaa053. - DOI - PMC - PubMed

[8] Van Duin D., Barlow G., Nathwani D. The impact of the COVID-19 pandemic on antimicrobial resistance: A debate. JAC-Antimicrob. Resist. 2020;3:dlaa053. doi: 10.1093/jacamr/dlaa053. - DOI - PMC - PubMed

[9] Loganathan B., Phillips M., Mowery H., Jones-Lepp T.L. Contamination profiles and mass loadings of macrolide antibiotics and illicit drugs from a small urban wastewater treatment plant. Chemosphere. 2009;75:70–77. doi: 10.1016/j.chemosphere.2008.11.047. - DOI - PubMed

[10] Loganathan B., Phillips M., Mowery H., Jones-Lepp T.L. Contamination profiles and mass loadings of macrolide antibiotics and illicit drugs from a small urban wastewater treatment plant. Chemosphere. 2009;75:70–77. doi: 10.1016/j.chemosphere.2008.11.047. - DOI - PubMed

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

Affiliations

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

Authors

Affiliations

Abstract

Conflict of interest statement

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