The impacts of New Zealand's COVID-19 epidemic response on community antibiotic use and hospitalisation for pneumonia, peritonsillar abscess and rheumatic fever

Abstract

Background The rate of community antibiotic use in New Zealand (NZ) is high and some may be unnecessary. Non-pharmaceutical public health interventions (Alert Levels) were implemented in 2020 to reduce the spread of COVID-19 in NZ and were likely to have affected antibiotic prescribing. Methods We aimed to identify the impact of these public health interventions on community antibiotic dispensing. We also examined rates of hospitalisation with infectious diseases that could be influenced by changing community antibiotic use. A retrospective review of two national databases was undertaken. Findings 1.17 million people received 1.19 million prescriptions for antibiotics between 23/02/2020 and 18/07/2020. Antibiotic dispensing rates fell from 14 prescriptions per 1000 population per week during pre-Alert Level weeks to 9 prescriptions per 1000 population per week (a reduction of 36%) during the weeks of COVID Alert Level 3–4. Large reductions were seen with antibiotics predominantly used for respiratory- or urinary-tract infections. Hospital discharges with sentinel infections did not increase over this period; pneumonia discharges during Alert Level weeks were lower than in 2017-2019 (3 vs 6 discharges per 100,000 population). Interpretation A large reduction in community antibiotic dispensing was observed in NZ during the implementation of non-pharmaceutical public health interventions to eliminate COVID-19. Despite this marked reduction in antibiotic use, there was no increase in rates of hospitalisation for sentinel infections that community antibiotic use could prevent. These findings suggest that countries with high rates of antibiotic use could significantly reduce their use without an increase in morbidity. Funding No financial support received.

Consumo de antibióticos en atención primaria en población adulta de Asturias durante el periodo 2014-2020

“…Esta tendencia se detecta en otros países, como Reino Unido o Portugal 18 , 19 , con un sistema sanitario parecido al nuestro y en otros continentes 20 , 21 , 22 . En un estudio del ámbito de AP 18 , la prescripción se redujo un 15,48% en el periodo de abril a agosto de 2020 respecto al mismo periodo de 2019, aunque, teniendo en cuenta el descenso experimentado en el número de consultas, consideran que el número de prescripciones fue un 6,71% mayor que el esperado.…”

“…En el estudio realizado en Nueva Zelanda 20 se concluye que, a pesar de la marcada reducción en la dispensación comunitaria de antibióticos observada durante la implementación de intervenciones de salud pública no farmacológicas para frenar la COVID-19, no hubo un aumento en las tasas de hospitalización por infecciones centinela que el uso de antibióticos en la comunidad podrían prevenir.…”

“…Además, esa reducción influye de forma importante en la evolución de la tasa de consumo anual durante 2014-2020. Este comportamiento del consumo de antibióticos en el periodo de pandemia se describe también en estudios de otros países 18 , 19 , 20 , 21 , 22 , y puede tener relación con cambios cuantitativos y cualitativos en la accesibilidad, en el perfil epidemiológico de las infecciones respiratorias, y en la propia práctica profesional.…”

Antimicrobial Resistance in New Zealand—A One Health Perspective

“…A clear seasonal pattern was observed with dispensing rates, highest in summer and autumn [ 31 ]. A recent NZ study compared antimicrobial dispensing before and after public health interventions were introduced in 2020 to reduce the spread of COVID-19 [ 32 ]. Duffy et al [ 32 ] found antimicrobial dispensing reduced by 36% during COVID alert levels 3 and 4 (lockdown).…”

“…A recent NZ study compared antimicrobial dispensing before and after public health interventions were introduced in 2020 to reduce the spread of COVID-19 [ 32 ]. Duffy et al [ 32 ] found antimicrobial dispensing reduced by 36% during COVID alert levels 3 and 4 (lockdown). These reductions were mainly seen for antimicrobials used to treat respiratory and urinary tract infections—but hospital admissions due to these infections did not increase.…”