The impact of COVID-19 on community antibiotic use in Canada: an ecological study

Knight, Braden; Shurgold, Jayson; Smith, Geoffrey C.; MacFadden, Derek R.; Schwartz, Kevin L; Daneman, Nick; Tropper, Denise Gravel; Brooks, James

doi:10.1016/j.cmi.2021.10.013

Cited by 43 publications

(34 citation statements)

References 21 publications

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“…In the United Kingdom, antibiotic prescribing rates in primary care were higher at the start of the pandemic (March 2020), but fell below expected rates between April and August 2020 [ 2 ]. Similar decreases in outpatient antibiotic prescriptions since the start of the pandemic have been found in Finland [ 3 ], the Netherlands [ 4 ], Spain [ 5 ], and Canada [ 6 ].…”

Section: Introductionsupporting

confidence: 64%

A Time Series Analysis Evaluating Antibiotic Prescription Rates in Long-Term Care during the COVID-19 Pandemic in Alberta and Ontario, Canada

et al. 2022

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The COVID-19 pandemic affected access to care, and the associated public health measures influenced the transmission of other infectious diseases. The pandemic has dramatically changed antibiotic prescribing in the community. We aimed to determine the impact of the COVID-19 pandemic and the resulting control measures on oral antibiotic prescribing in long-term care facilities (LTCFs) in Alberta and Ontario, Canada using linked administrative data. Antibiotic prescription data were collected for LTCF residents 65 years and older in Alberta and Ontario from 1 January 2017 until 31 December 2020. Weekly prescription rates per 1000 residents, stratified by age, sex, antibiotic class, and selected individual agents, were calculated. Interrupted time series analyses using SARIMA models were performed to test for changes in antibiotic prescription rates after the start of the pandemic (1 March 2020). The average annual cohort size was 18,489 for Alberta and 96,614 for Ontario. A significant decrease in overall weekly prescription rates after the start of the pandemic compared to pre-pandemic was found in Alberta, but not in Ontario. Furthermore, a significant decrease in prescription rates was observed for antibiotics mainly used to treat respiratory tract infections: amoxicillin in both provinces (Alberta: −0.6 per 1000 LTCF residents decrease in weekly prescription rate, p = 0.006; Ontario: −0.8, p < 0.001); and doxycycline (−0.2, p = 0.005) and penicillin (−0.04, p = 0.014) in Ontario. In Ontario, azithromycin was prescribed at a significantly higher rate after the start of the pandemic (0.7 per 1000 LTCF residents increase in weekly prescription rate, p = 0.011). A decrease in prescription rates for antibiotics that are largely used to treat respiratory tract infections is in keeping with the lower observed rates for respiratory infections resulting from pandemic control measures. The results should be considered in the contexts of different LTCF systems and provincial public health responses to the pandemic.

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Section: Introductionsupporting

confidence: 64%

A Time Series Analysis Evaluating Antibiotic Prescription Rates in Long-Term Care during the COVID-19 Pandemic in Alberta and Ontario, Canada

et al. 2022

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“…Thus, improving microbiological capabilities would certainly optimise antibiotic prescribing, particularly early de-escalation. Nevertheless, further efforts are needed to prevent antibiotic misuse in the hospital setting and studies in Canada and the US have shown successful reductions in antibiotic prescribing [ 21 , 22 ]. In our country, it seems evident that recommendations for antibiotic prescribing and use are not being followed.…”

Section: Discussionmentioning

confidence: 99%

Antibiotic (Mis)Use in COVID-19 Patients before and after Admission to a Tertiary Hospital in Serbia

et al. 2022

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Antimicrobial resistance (AMR) is a global concern, and antibiotic use has risen throughout the COVID-19 pandemic. Up to 75% of COVID-19 patients are treated with antibiotics despite little evidence for their use. A retrospective study from 6 March 2020 (the start of the pandemic in Serbia) to 31 December 2021 was conducted at the Clinic for Infectious and Tropical Diseases, University Clinical Centre of Serbia. In total, 523 patients with a microbiological diagnosis of COVID-19 were included. Patient data were analysed, including antibiotic use before and after admission. Pre-admission use of antibiotics for COVID-19 treatment was documented in more than half of patients (58.1%), of which a third (34.1%) used more than one antibiotic. Macrolides, cephalosporins, and fluoroquinolones were mainly used, most frequently among patients aged between 31–45 years (75.2%). Prior antibiotic use was associated with a longer duration of illness at admission (8.8 vs. 5.7, p < 0.001), oxygen therapy upon admission (27.6% vs. 16.0%, p = 0.002), and a lower vaccination rate (60.7% vs. 50.7%, p = 0.04). When hospitalised, 72.1% of patients received antibiotics, primarily cephalosporins (71.9%). Significant efforts are needed to reduce antibiotic use in the community and improve prescribing rates by healthcare professionals.

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“…Furthermore, the reforms introduced depend on human action to reduce shortages. Current data 22 show that most exceptional importation activity occurred during the summer of 2020 but slowed thereafter (Appendix 1, Supplementary Figure, available at www.cmaj.ca/lookup/doi/10.1503/cmaj.212070/tab-related-content ). Although fewer opportunities may exist in subsequent years to resolve shortages via importation, authorities must remain vigilant to maintain the progress made in 2020.…”

Section: Discussionmentioning

confidence: 99%

COVID-19 and the prevalence of drug shortages in Canada: a cross-sectional time-series analysis from April 2017 to April 2022

Lau

Tadrous

Chu

et al. 2022

CMAJ

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Background: In March 2020, the Government of Canada introduced measures to reduce intensifying shortages of prescription drugs during the beginning of the COVID-19 pandemic. We sought to assess the extent to which a decline in drug shortages was observed in the months after this policy change. Methods: Our data source was the Drug Shortages Canada Database, which reports shortages by drug product, including shortage start and duration. Using a cross-sectional design, we tracked shortage rates of drug products using a 30-day moving average from Apr. 15, 2017, to Apr. 1, 2022. We used autoregressive integrated moving average modelling with a ramp function to determine the significance of trend changes after policy implementation. Results: We found that of the 13 329 drug products at risk for shortage, 44.7% ( n = 5953) had at least 1 shortage event in the past 5 years. Average daily shortage prevalence rates rose from 901 in April 2017 to a peak of 2345 by April 2020. Significant declines ( p = 0.02) ensued shortly thereafter, dropping to a rate of 1611 shortages by the end of the first year after policy implementation. However, we did not observe a significant reduction in shortage rates in the second year ( p = 0.2), with rates plateauing below 1500 and then rising back above 1600 by the end of March 2022. Interpretation: Drug shortages are common in Canada, including during the initial months of the COVID-19 pandemic. We observed substantial improvements after the implementation of the new measures, but gains appear to have plateaued. Continued vigilance is needed to sustain improvements.

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The impact of COVID-19 on community antibiotic use in Canada: an ecological study

Cited by 43 publications

References 21 publications

A Time Series Analysis Evaluating Antibiotic Prescription Rates in Long-Term Care during the COVID-19 Pandemic in Alberta and Ontario, Canada

A Time Series Analysis Evaluating Antibiotic Prescription Rates in Long-Term Care during the COVID-19 Pandemic in Alberta and Ontario, Canada

Antibiotic (Mis)Use in COVID-19 Patients before and after Admission to a Tertiary Hospital in Serbia

COVID-19 and the prevalence of drug shortages in Canada: a cross-sectional time-series analysis from April 2017 to April 2022

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