Surveillance of Antibacterial Usage during the COVID-19 Pandemic in England, 2020

Abstract

Changes in antibacterial prescribing during the COVID-19 pandemic were anticipated given that the clinical features of severe respiratory infection syndrome caused by SARS-CoV-2 mirror bacterial respiratory tract infections. Antibacterial consumption was measured in items/1000 population for primary care and in Defined Daily Doses (DDDs)/1000 admissions for secondary care in England from 2015 to October 2020. Interrupted time-series analyses were conducted to evaluate the effects of the pandemic on antibacterial consumption. In the community, the rate of antibacterial items prescribed decreased further in 2020 (by an extra 1.4% per month, 95% CI: −2.3 to −0.5) compared to before COVID-19. In hospitals, the volume of antibacterial use decreased during COVID-19 overall (−12.1% compared to pre-COVID, 95% CI: −19.1 to −4.4), although the rate of usage in hospitals increased steeply in April 2020. Use of antibacterials prescribed for respiratory infections and broad-spectrum antibacterials (predominately ‘Watch’ antibacterials in hospitals) increased in both settings. Overall volumes of antibacterial use at the beginning of the COVID-19 pandemic decreased in both primary and secondary settings, although there were increases in the rate of usage in hospitals in April 2020 and in specific antibacterials. This highlights the importance of antimicrobial stewardship during pandemics to ensure appropriate prescribing and avoid negative consequences on patient outcomes and antimicrobial resistance.

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“…In Portugal, the current pandemic is associated with an immediate decrease in overall antibiotic prescriptions, probably due to mandatory home confinement, social distancing, isolation, and routine use of masks; this trend was not confirmed in the long term (T. M. . A similar trend was observed in England, although antibiotic use in hospitals increased steeply in April 2020 (Andrews et al, 2021).…”

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“…Despite the overall trend of decrease in antibiotics usage during 2019–2020. During the first months of the outbreak, a slight increase in prescribing antibiotics was reported in England between March 2020 compared to March 2019 [ 25 ]. Only after, in May 2020, the WHO published guidelines for appropriate usage of antibiotics when managing COVID-19, and increased awareness followed by a decrease in antibiotic use was noted in the primary healthcare setting [ 25 ].…”

Impact of the COVID-19 Pandemic on Community Antibiotic Prescribing and Stewardship: A Qualitative Interview Study with General Practitioners in England

“…It is also possible that too few antibiotics were prescribed (e.g., considering a peak in community-acquired bloodstream infections in May 2020 [ 36 ]). Therefore, these fluctuations (including the numbers of prescriptions and consultations) need to be considered when interpreting changes in antibiotic prescribing during the pandemic [ 19 , 21 , 22 , 23 ]. Investigating the appropriateness of antibiotic prescribing against guidelines, antibiotic prescribing in COVID-19/hot hubs and patients’ help-seeking as well as self-management behaviours would also provide helpful insights.…”

“…Studies from primary care in England have shown an overall decrease in antibiotic prescribing during 2020 compared to pre-pandemic [18][19][20][21][22][23], with similar trends identified in Scotland [24], Northern Ireland [25] and other countries [26][27][28][29]. However, one study on UK data noted an initial increase in antibiotic prescribing in March 2020 before prescribing levels dropped below those expected (with the lowest rate in May) [20].…”