Association of Changes in Seasonal Respiratory Virus Activity and Ambulatory Antibiotic Prescriptions With the COVID-19 Pandemic

Abstract

The COVID-19 pandemic led to numerous measures to mitigate the spread of SARS-CoV-2, including cancellations of gatherings, closure of businesses and schools, social distancing, wearing face masks, and other hygiene measures. 1 These may have unintended positive associations with reducing other respiratory infections. As antibiotics are frequently inappropriately prescribed for viral respiratory diseases, 2 we hypothesized that a decreased respiratory virus incidence would be associated with reduced ambulatory antibiotic orders.Methods | We conducted a pre-post study consisting of a pre-COVID-19 pandemic period (July 2018 to February 2020), a 1-month run-in period (March 2020), and a COVID-19 pandemic period (April 2020 to February 2021). This study received an institutional review board exemption from the University of Wisconsin because it used aggregate prescribing data only, without any patient or clinician identifiers. The Wisconsin State Laboratory of Hygiene provided weekly statewide surveillance polymerase chain reaction data for the following respiratory viruses: influenza, respiratory syncytial virus, human parainfluenza virus, human metapneumovirus, seasonal coronavirus, adenovirus, and enterovirus/ rhinovirus. University of Wisconsin Health is a large, academic health system that serves southern Wisconsin, with more than 80 ambulatory sites and 7 000 000 annual ambulatory encounters. Ambulatory antibiotic prescribing data were collected for all University of Wisconsin Health ambulatory clinics, visit types (eg, in person, telemedicine, and telephone), and ages. We calculated the number of monthly antibiotic prescriptions per 1000 patient encoun-

Appropriateness of Antibiotic Prescriptions in Chinese Primary Health Care and the Impact of the COVID-19 Pandemic: A Typically Descriptive and Longitudinal Database Study in Yinchuan City

“…We found that the COVID-19 pandemic was associated with a decrease in overall and inappropriate antibiotic prescriptions in Chinese primary care facilities, with immediate levels decreasing in March 2020, and increasing trends thereafter. Similar effects have been observed in other studies ( Buehrle et al, 2020 ; King et al, 2020 ; Lepak et al, 2021 ; Miller et al, 2021 ). The COVID-19 pandemic has brought about a wide range of changes in the structure of health services, health-seeking behaviors, and medication supplies ( Knight et al, 2021 ).…”

“…The COVID-19 pandemic has brought about a wide range of changes in the structure of health services, health-seeking behaviors, and medication supplies ( Knight et al, 2021 ). Measures implemented to prevent and control the spread of COVID-19, including social isolation, use of personal protective equipment, hand and environmental hygiene, and active identification and quarantine of close contacts, have been effective in reducing the incidence of other infectious diseases, thus indirectly reducing antibiotic prescriptions for both necessary and unnecessary use ( Buehrle et al, 2020 ; King et al, 2020 ; Parry et al, 2020 ; Knight et al, 2021 ; Lai et al, 2021 ; Lepak et al, 2021 ; Miller et al, 2021 ). Early in the pandemic, antibiotics and other anti-inflammatory agents were partially unavailable in pharmacies and primary care institutions in China, and physicians prescribed these drugs carefully, fearing delays in identifying potential COVID-19 patients because of patient self-medication or insufficient diagnostic capabilities in primary care facilities.…”

“…Interrupted time series analyses using segmented linear regressions were conducted to assess the impact of the COVID-19 pandemic on antibiotic prescription rates and proportions of inappropriate antibiotic prescriptions. Given the delay of the intervention effect, March 2020, when the WHO declared COVID-19 a pandemic, was set as the time when the pandemic began to have an impact, according to descriptive trend analyses and previous studies ( Buehrle et al, 2020 ; Agca et al, 2021 ; Lepak et al, 2021 ).…”

“…Furthermore, these studies have been conducted through manual prescription reviews ( Wang et al, 2014 ; Chang et al, 2019 ; Taxifulati et al, 2021 ), which are highly dependent on the pharmacist’s or physician’s level of experience ( Zhao et al, 2021a ). In addition, several studies have indicated that the coronavirus disease 2019 (COVID-19) pandemic could have significant effects on antibiotic prescriptions ( Buehrle et al, 2020 ; King et al, 2020 ; Lepak et al, 2021 ), whereas this evidence is scarce in China. Detailed analyses of antibiotic use throughout this pandemic will help to understand the impact of COVID-19 and inform strategies for controlling AMR ( Knight et al, 2021 ; Miller et al, 2021 ).…”

Has the COVID-19 pandemic wiped out the seasonality of outpatient antibiotic use and influenza activity? A time-series analysis from 2014 to 2021

“…Consistent with the outcomes that we found in our setting with more than 1,500 centres, rates of prescriptions and influenza and non-influenza virus detections decreased during the pandemic period. Nevertheless, non-influenza virus detections presented the strongest correlation with antibiotic use for ARTIs in that study [ 27 ].…”