Consumption Trends of Antibiotics in Brazil During the COVID-19 Pandemic

Abstract

Background: In 2019, a new type of coronavirus emerged and spread to the rest of the world. Numerous drugs were identified as possible treatments. Among the candidates for possible treatment was azithromycin alone or in combination with other drugs. As a result, many clinicians in Brazil have prescribed azithromycin in an attempt to combat or minimize the effects of COVID19.Aim: This study analyzed the sales data of the main antibiotics prescribed in Brazil to verify the change in consumption trends of these drugs during the COVID-19 pandemic.Methods: This is an interrupted time series that analyzed antimicrobial sales data between January 2014 and July 2021, publicly accessible information obtained from the Brazilian government’s website. Monthly means of “defined daily doses of DDDs” (DDDs per 1,000 inhabitants per day) of antibiotics were compared by analysis of variance, followed by the Dunnett Multiple Comparisons Test. Monthly trend changes in antibiotic use were verified using Joinpoint regression.Results: Amoxicillin (31.97%), azithromycin (18.33%), and cefalexin (16.61%) were the most sold antibiotics in Brazil during the evaluation period. Azithromycin consumption rose from 1.40 DDDs in February 2020 to 3.53 DDDs in July 2020. Azithromycin sales showed a significant increase in the pandemic period [Monthly Percent Change (MPC) 5.83%, 95% 1.80; 10.00], whereas there was a fall in amoxicillin sales (MPC −9.00%, 95% CI −14.70; −2.90) and cefalexin [MPC-2.70%, 95% (CI −6.30; −1.10)] in this same period.Conclusion: The COVID-19 pandemic changed the pattern of antibiotic consumption in Brazil, with a decrease in the use of amoxicillin and cefalexin and an increase in the consumption of azithromycin.

Consumption of Antibiotics in Primary Care Setting before and during COVID-19 Pandemic in Republic of Srpska, Bosnia and Herzegovina

“…A probable explanation for such a large outpatient consumption of first-generation cephalosporins is the fact that cephalexin is the only cephalosporin that can be obtained with prescription without extra compensation in the RS, or more precisely, the low living standard compared to the high prices of other cephalosporins. Contrary to the results of our study, in 2020 there was a decrease in consumption of first-generation cephalosporins and amoxicillin in Brazil, which was explained by a decrease in all respiratory infections except for COVID-19 [ 24 ]. The consumption of macrolides was significantly higher in 2020 compared to 2019 in all regions of the RS, which was also registered in all neighboring countries and globally [ 25 ].…”

Evaluation of pharmacist’s practices regarding the antimicrobials dispensing: a simulated patient study

“…In both cases, antimicrobials can only obtain through the prescription of a professional qualified to prescribe and dispensed by pharmacists or under their supervision [ 7 , 8 , 14 ]. Although there are regulations regarding the sale of antimicrobials, enforcement of and compliance with these measures is considered an old issue and difficult to operationalize in view of economic, cultural, information, education, and inspection factors [ 15 , 16 ].…”

Potential safety signals for antibacterial agents from the Brazilian national pharmacovigilance database (Vigimed/VigiFlow)

“…Accumulating azithromycin in brain tissue can prove unpredictable effects ( Jaruratanasirikul et al, 1996 ), a possible mechanism by which azithromycin causes gait disturbance. The pandemic caused by COVID-19 increased azithromycin consumption in Brazil ( Del Fiol et al, 2022 ). This scenario may have contributed to the emergence of safety signals not previously observed ( Meyboom et al, 1997 ) ( Figure 1 ).…”