Antibiotic Consumption in Vanuatu before and during the COVID-19 Pandemic, 2018 to 2021: An Interrupted Time Series Analysis

Abstract

The study objectives were to examine antibiotic consumption at Vila Central Hospital (VCH), Vanuatu between January 2018 and December 2021 and the influence of the COVID-19 pandemic on antibiotic consumption during this period. Data on antibiotic usage were obtained from the Pharmacy database. We used the WHO’s Anatomical Therapeutic Classification/Defined Daily Dose (ATC/DDD) index, VCH’s inpatient bed numbers and the hospital’s catchment population to calculate monthly antibiotic consumption. The results were expressed as DDDs per 100 bed days for inpatients (DBDs) and DDDs per 1000 inhabitants per day for outpatients (DIDs). Interrupted time series (ITS) was used to assess the influence of COVID-19 by comparing data before (January 2018 to January 2020) and during (February 2020 to December 2021) the pandemic. Ten antibiotics were examined. In total, 226 DBDs and 266 DBDs were consumed before and during COVID-19 by inpatients, respectively with mean monthly consumption being significantly greater during COVID-19 than before the pandemic (2.66 (p = 0.009, 95% CI 0.71; 4.61)). Whilst outpatients consumed 102 DIDs and 92 DIDs before and during the pandemic, respectively, the difference was not statistically significant. Findings also indicated that outpatients consumed a significantly lower quantity of Watch antibiotics during COVID-19 than before the pandemic (0.066 (p = 0.002, 95% CI 0.03; 0.11)). The immediate impact of COVID-19 caused a reduction in both inpatient and outpatient mean monthly consumption by approximately 5% and 16%, respectively, and this was followed by an approximate 1% monthly increase until the end of the study. By mid-2021, consumption had returned to pre-pandemic levels.

The Impact of COVID-19 on Knowledge, Beliefs, and Practices of Ni-Vanuatu Health Workers Regarding Antibiotic Prescribing and Antibiotic Resistance, 2018 and 2022: A Mixed Methods Study

“…Knowledge about antibiotic prescribing improved across both professional groups. There are several possible explanations for this improvement: time between the surveys will have enabled health workers to gain more experience and increase their prescribing competency, and discussion amongst colleagues about different treatment regimens has been shown to improve prescribing practice [31]; and pandemic preparedness included "inhouse" training about treatment planning for viral and bacterial infections [32]. Further, responses from interviewees and open-ended questions support the hypothesis that prescribers believed the pandemic may have improved their antibiotic prescribing practices, "changed our prescribing", "stricter", "more careful", ''over-emphasising counselling for viral infections now as they do not need to be treated with antibiotics".…”

Pharmacoepidemiological Analysis of Antibacterial Agents Used in a Provisional Hospital in Aktobe, Kazakhstan, in the Context of COVID-19: A Comparison with the Pre-Pandemic Period

“…Azithromycin, a readily accessible antibacterial drug, boasts a generally commendable safety profile. Notably, azithromycin holds the potential to address co-existing infections and secondary bacterial infections that might manifest in patients suffering from respiratory viral conditions [24,25]. However, the pervasive prescription of this antibiotic during the pandemic is a cause for concern.…”

Antibiotic resistance and the COVID‐19 pandemic: A dual crisis with complex challenges in LMICs

“… 39 A study from Vanuatu, a small LMIC situated in southwest Pacific, reported that there was an escalation in the usage of antibiotics during the COVID‐19 pandemic than before. 40 Similarly in Pakistan, enormous increases in consumption of azithromycin have been reported. 41 Further, the pecuniary shocks brought on by COVID‐19 regulations may make it more necessary for people in LMICs, where antimicrobial purchases are already prone to less scrutiny, to misuse them in an effort to cut healthcare costs.…”

“…Similarly, the multisymptoms characteristic of COVID‐19 coinciding with other infections such as tuberculosis (cough) and malaria (fever) also lead to misdiagnosis and misapplication of antimicrobials 39 . A study from Vanuatu, a small LMIC situated in southwest Pacific, reported that there was an escalation in the usage of antibiotics during the COVID‐19 pandemic than before 40 . Similarly in Pakistan, enormous increases in consumption of azithromycin have been reported 41 .…”