Antibiotics in the Community During the COVID-19 Pandemic: A Qualitative Study to Understand Users’ Perspectives of Antibiotic Seeking and Consumption Behaviors in Bangladesh

Abstract

Introduction The COVID-19 pandemic is thought to have led to increased “inappropriate” or “unjustified” seeking and consumption of antibiotics by individuals in the community. However, little reference has been made to antibiotic seeking and using behaviors from the perspectives of users in Bangladesh during this health crisis. Purpose This study seeks to document how antibiotic medicines are sought and used during a complex health crisis, and, within different contexts, what are the nuanced reasons why patients may utilize these medicines sub-optimally. Methods We used an exploratory, qualitative design. Forty semi-structured telephone interviews were conducted with people diagnosed with COVID-19 (n=20), who had symptoms suggestive of COVID-19 (n=20), and who had received care at home in two cities between May and June 2021 in Bangladesh. In this study, an inductive thematic analysis was performed. Results The analysis highlighted the interlinked relationships of antibiotic seeking and consumption behaviors with the diversity of information disseminated during a health crisis. Antibiotic-seeking behaviors are related to previous experience of use, perceived severity of illness, perceived vulnerability, risk of infection, management of an “unknown” illness and anxiety, distrust of expert advice, and intrinsic agency on antimicrobial resistance (AMR). Suboptimal adherence, such as modifying treatment regimes and using medication prescribed for others, were found to be part of care strategies used when proven therapeutics were unavailable to treat COVID-19. Early cessation of therapy was found to be a rational practice to avoid side effects and unknown risks. Conclusion Based on the results, we highly recommend the take up of a pandemic specific antimicrobial stewardship (AMS) program in the community. To deliver better outcomes of AMS, incorporating users’ perspectives could be a critical strategy. Therefore, a co-produced AMS intervention that is appropriate for a specific cultural context is an essential requirement to reduce the overuse of antibiotics during the COVID-19 pandemic and beyond.

Impact of the COVID-19 Outbreak on the Antibiotic Use Patterns among a Rural Community Population in Eastern China

“…It was found that the proportion of cephalosporins increased significantly in this study population in 2020 compared with 2019, which was supported by previous studies [ 44 , 50 ]. A recent study reported that the use of third-generation cephalosporins increased by 19% in 2020 compared with 2019 [ 38 ].…”

“…Although the impact of the COVID-19 outbreak on antibiotic consumption has been documented in some epidemiological studies, few of them were conducted among community populations because the reliable data on antibiotic use are largely limited to hospitalized patients [ 39 , 40 , 49 , 50 ]. Our study estimated that the risk of antibiotic use increased by 137% after the COVID-19 outbreak in China, while it was reduced to 72% after the control of the covariates.…”

“…In such circumstances, doctors might agree to prescribe antibiotics, allowing people to obtain antibiotics easily. Another study elsewhere in Asia indicated that antibiotic-seeking behavior was related to a perceived vulnerability, management of an “unknown” illness, and anxiety [ 50 ], while an earlier Dutch study showed that if patients expected an antibiotic prescription, they were more likely to receive one [ 53 ]. Correspondingly, our study also showed that the proportion of medical facility-sourced antibiotics increased after the outbreak, in part, perhaps, because the availability of antibiotics purchased over the counter was increasingly restricted after the start of the pandemic.…”

“…Controversially, some studies suggested that the use of several antibiotics increased in 2020 compared to 2019 [ 41 , 42 , 43 , 44 , 45 ], despite the fact that many studies reported that the total antibiotic consumption decreased during or after COVID-19 in Europe [ 40 ], the United States [ 46 , 47 ], Singapore [ 48 ], and China [ 39 ]. So far, few studies have focused on the impact of COVID-19 on antibiotic use among the community population [ 49 , 50 ]. Hogberg et al reported that community antibiotic consumption decreased in nearly all EU/EEA countries during COVID-19 [ 49 ].…”

“…Hogberg et al reported that community antibiotic consumption decreased in nearly all EU/EEA countries during COVID-19 [ 49 ]. Furthemore, Kalam conducted a qualitative study to understand users’ perspectives on antibiotic seeking and consumption during COVID-19 [ 50 ]. Nevertheless, the changes in antibiotic use patterns were not clear, which may prompt evidence of how COVID-19 affects antibiotic resistance.…”