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Impact of Pandemic of COVID-19 on Antibiotic Prescription/Sales and on...
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Impact of Pandemic of COVID-19 on Antibiotic Prescription/Sales and on Antibiotic Resistances

A special issue of Antibiotics (ISSN 2079-6382). This special issue belongs to the section "Antibiotics Use and Antimicrobial Stewardship".

Deadline for manuscript submissions: closed (31 December 2021) | Viewed by 30161

Special Issue Editor

Prof. Dr. Adolfo Figueiras

E-Mail Website
Guest Editor
1. Department of Preventive Medicine, University of Santiago de Compostela, R/ San Francisco, s/n, 15782 Santiago, Spain
2. Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBER-ESP), Madrid, Spain
3. Health Research Institute of Santiago de Compostela (IDIS), Santiago, Spain
Interests: pharmacology; pharmacogenetics; epidemiology; medicine misuse; pharmacovigilance; public health

Special Issue Information

Dear Colleagues,

COVID-19 can present as a severe respiratory infection, and is being or has been treated with a wide variety of antibiotics. Accordingly, there is profound concern globally about the impact that the COVID-19 pandemic may have on the overprescription of antibiotics, in view of the consequences which this could have for humans, animals, and the environment. Even so, there are few studies on this topic, and the main subjects of this Special Issue thus include:

  1. An assessment of the impact on the prescription/sale of antibiotics as a whole at a country and/or regional level;
  2. The effect on the amount of antibiotics prescribed, by reference to the health care setting (primary care/hospital care/emergencies/critical care); and,
  3. Trends in the prescribing of watch and/or reserve group antibiotics, according to the WHO criteria.

Of special interest in this respect are studies conducted across extensive geographical areas such as regions or countries, which, on the basis of a number of papers, would enable an idea to be formed of the impact on the prescription/sale of antibiotics worldwide.

Prof. Adolfo Figueiras
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Antibiotics is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • SARS-CoV-2
  • COVID-19
  • Antimicrobial
  • Antibiotic
  • Antimicrobial Drug Resistance
  • Antibiotic Resistance
  • Interrupted Time Series Analysis
  • Health Impact Assessment

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Published Papers (6 papers)

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Research

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17 pages, 1511 KiB  
Article
Interrupted Time Series Analysis of Pediatric Infectious Diseases and the Consumption of Antibiotics in an Atlantic European Region during the SARS-CoV-2 Pandemic
by Ana Clavería, María Victoria Delgado-Martín, Ana Goicoechea-Castaño, José Manuel Iglesias-Moreno, Clara García-Cendón, María Victoria Martín-Miguel, Rita Villarino-Moure, Carolina Barreiro-Arceiz, Isabel Rey-Gómez-Serranillos and Javier Roca
Antibiotics 2022, 11(2), 264; https://doi.org/10.3390/antibiotics11020264 - 18 Feb 2022
Cited by 2 | Viewed by 3048
Abstract
The increasing concern about bacterial resistance has made the rational prescription of antibiotics even more urgent. The non-pharmacological measures established to reduce the impact of the SARS-CoV-2 pandemic have modified the epidemiology of pediatric infections and, consequently, the use of antibiotics. Interrupted time [...] Read more.
The increasing concern about bacterial resistance has made the rational prescription of antibiotics even more urgent. The non-pharmacological measures established to reduce the impact of the SARS-CoV-2 pandemic have modified the epidemiology of pediatric infections and, consequently, the use of antibiotics. Interrupted time series (ITS) analyses are quasi-experimental studies that allow for the estimation of causal effects with observational data in “natural experiments”, such as changes in health policies or pandemics. The effect of the SARS-CoV-2 pandemic on the incidence of infectious diseases and the use of antibiotics between 2018 and 2020 in the Health Area of Vigo (Galicia, Spain) was quantified and analyzed. This paper outlines a real-world data study with administrative records from primary care services provided for the pediatric population. The records were related to episodes classified as infectious by the International Classification of Primary Care (ICPC-2) and oral medication in the therapeutic subgroup J01, corresponding to antibiotics for systemic use, according to the World Health Organization’s Anatomical Therapeutic Chemical (ATC) classification system. The records were classified according to incident episodes, age, dose per inhabitant, and year. Segmented regression models were applied using an algorithm that automatically identifies the number and position of the change points. During the SARS-CoV-2 pandemic, the number of infectious diseases being transmitted between individuals, through the air and through the fecal–oral route, significantly decreased, and a slight decrease in infections transmitted via other mechanisms (urinary tract infections) was also found. In parallel, during the months of the pandemic, there has been a marked and significant reduction in antibacterial agent utilization, mainly of penicillins, cephalosporins, and macrolides. Full article
(This article belongs to the Special Issue Impact of Pandemic of COVID-19 on Antibiotic Prescription/Sales and on Antibiotic Resistances)
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10 pages, 1030 KiB  
Article
Antibiotic Prescribing Trends in Belgian Out-of-Hours Primary Care during the COVID-19 Pandemic: Observational Study Using Routinely Collected Health Data
by Annelies Colliers, Jeroen De Man, Niels Adriaenssens, Veronique Verhoeven, Sibyl Anthierens, Hans De Loof, Hilde Philips, Samuel Coenen and Stefan Morreel
Antibiotics 2021, 10(12), 1488; https://doi.org/10.3390/antibiotics10121488 - 4 Dec 2021
Cited by 14 | Viewed by 3615
Abstract
Antibiotic overprescribing is one of the main drivers of the global and growing problem of antibiotic resistance, especially in primary care and for respiratory tract infections (RTIs). RTIs are the most common reason for patients to consult out-of-hours (OOH) primary care. The COVID-19 [...] Read more.
Antibiotic overprescribing is one of the main drivers of the global and growing problem of antibiotic resistance, especially in primary care and for respiratory tract infections (RTIs). RTIs are the most common reason for patients to consult out-of-hours (OOH) primary care. The COVID-19 pandemic has changed the way general practitioners (GPs) work, both during office hours and OOH. In Belgian OOH primary care, remote consultations with the possibility of issuing prescriptions and telephone triage were implemented. We aimed to describe the impact of COVID-19 on GPs’ antibiotic prescribing during OOH primary care. In an observational study, using routinely collected health data from GP cooperatives (GPCs) in Flanders, we analyzed GPs’ antibiotic prescriptions in 2019 (10 GPCs) and 2020 (20 GPCs) during OOH consultations (telephone and face-to-face). We used autoregressive integrated moving average (ARIMA) modeling to identify any changes after lockdowns were implemented. In total, 388,293 contacts and 268,430 prescriptions were analyzed in detail. The number of antibiotic prescriptions per weekend, per 100,000 population was 11.47 (95% CI: 9.08–13.87) or 42.9% lower after compared to before the implementation of lockdown among all contacts. For antibiotic prescribing per contact, we found a decrease of 12.2 percentage points (95% CI: 10.6–13.7) or 56.5% among all contacts and of 5.3 percentage points (95% CI: 3.7–6.9) or 23.2% for face-to-face contacts only. The decrease in the number of prescriptions was more pronounced for cases with respiratory symptoms that corresponded with symptoms of COVID-19 and for antibiotics that are frequently prescribed for RTIs, such as amoxicillin (a decrease of 64.9%) and amoxicillin/clavulanate (a decrease of 38.1%) but did not appear for others such as nitrofurantoin. The implementation of COVID-19 lockdown measures coincided with an unprecedented drop in the number of antibiotic prescriptions, which can be explained by a decrease in face-to-face patient contacts, as well as a lower number of antibiotics prescriptions per face-to-face patient contact. The decrease was seen for antibiotics used for RTIs but not for nitrofurantoin, the first-choice antibiotic for urinary tract infections. Full article
(This article belongs to the Special Issue Impact of Pandemic of COVID-19 on Antibiotic Prescription/Sales and on Antibiotic Resistances)
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14 pages, 3126 KiB  
Article
The Impact of the COVID-19 Pandemic on Antibiotic Prescribing Trends in Outpatient Care: A Nationwide, Quasi-Experimental Approach
by Tânia Magalhães Silva, Marta Estrela, Eva Rebelo Gomes, Maria Piñeiro-Lamas, Adolfo Figueiras, Fátima Roque and Maria Teresa Herdeiro
Antibiotics 2021, 10(9), 1040; https://doi.org/10.3390/antibiotics10091040 - 25 Aug 2021
Cited by 25 | Viewed by 4680
Abstract
Coronavirus disease 2019 (COVID-19) has spread globally and is currently having a damaging impact on nearly all countries in the world. The implementation of stringent measures to stop COVID-19 dissemination had an influence on healthcare services and associated procedures, possibly causing antibiotic consumption [...] Read more.
Coronavirus disease 2019 (COVID-19) has spread globally and is currently having a damaging impact on nearly all countries in the world. The implementation of stringent measures to stop COVID-19 dissemination had an influence on healthcare services and associated procedures, possibly causing antibiotic consumption fluctuations. This paper aims to evaluate the immediate and long-term impact of the COVID-19 pandemic on antibiotic prescribing trends in outpatient care of the Portuguese public health sector, including in primary healthcare centers and hospitals, as well as on specific antibiotic groups known to be closely associated with increased resistance. Segmented regression analysis with interrupted time series data was used to analyze whether the COVID-19 pandemic had an impact in antibiotic prescribing tendencies at a national level. The outcomes from this quasi-experimental approach demonstrate that, at the beginning of the pandemic, a significant, immediate decrease in the overall antibiotic prescribing trends was noticed in the context of outpatient care in Portugal, followed by a statistically non-significant fall over the long term. The data also showed a significant reduction in the prescription of particular antibiotic classes (antibiotics from the Watch group, 3rd-generation cephalosporins, fluoroquinolones, and clarithromycin) upon COVID-19 emergence. These findings revealed an important disruption in antibiotics prescribing caused by the current public health emergency. Full article
(This article belongs to the Special Issue Impact of Pandemic of COVID-19 on Antibiotic Prescription/Sales and on Antibiotic Resistances)
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10 pages, 2203 KiB  
Article
Trends of Multidrug-Resistant Pathogens, Difficult to Treat Bloodstream Infections, and Antimicrobial Consumption at a Tertiary Care Center in Lebanon from 2015–2020: COVID-19 Aftermath
by Amanda Chamieh, Rita Zgheib, Sabah El-Sawalhi, Laure Yammine, Gerard El-Hajj, Omar Zmerli, Claude Afif, Jean-Marc Rolain and Eid Azar
Antibiotics 2021, 10(8), 1016; https://doi.org/10.3390/antibiotics10081016 - 21 Aug 2021
Cited by 12 | Viewed by 4176
Abstract
Introduction: We studied the trend of antimicrobial resistance and consumption at Saint George Hospital University Medical Center (SGHUMC), a tertiary care center in Beirut, Lebanon, with a focus on the SARS-CoV-2 pandemic. Materials and Methods: We calculated the isolation density/1000 patient-days (PD) of [...] Read more.
Introduction: We studied the trend of antimicrobial resistance and consumption at Saint George Hospital University Medical Center (SGHUMC), a tertiary care center in Beirut, Lebanon, with a focus on the SARS-CoV-2 pandemic. Materials and Methods: We calculated the isolation density/1000 patient-days (PD) of the most isolated organisms from 1 January 2015–31 December 2020 that included: E. coli (Eco), K. pneumoniae (Kp), P. aeruginosa (Pae), A. baumannii (Ab), S. aureus (Sau), and E. faecium (Efm). We considered March–December 2020 a surrogate of COVID-19. We considered one culture/patient for each antimicrobial susceptibility and excluded Staphylococcus epidermidis, Staphylococcus coagulase-negative, and Corynebacterium species. We analyzed the trends of the overall isolates, the antimicrobial susceptibilities of blood isolates (BSI), difficult-to-treat (DTR) BSI, carbapenem-resistant Enterobacteriaceae (CRE) BSI, and restricted antimicrobial consumption as daily-defined-dose/1000 PD. DTR implies resistance to carbapenems, beta-lactams, fluoroquinolones, and additional antimicrobials where applicable. Results and Discussion: After applying exclusion criteria, we analyzed 1614 blood cultures out of 8314 cultures. We isolated 85 species, most commonly Eco, at 52%. The isolation density of total BSI in 2020 decreased by 16%: 82 patients were spared from bacteremia, with 13 being DTR. The isolation density of CRE BSI/1000 PD decreased by 64% from 2019 to 2020, while VREfm BSI decreased by 34%. There was a significant decrease of 80% in Ab isolates (p-value < 0.0001). During COVID-19, restricted antimicrobial consumption decreased to 175 DDD/1000 PD (p-value < 0.0001). Total carbapenem consumption persistently decreased by 71.2% from 108DDD/1000 PD in 2015–2019 to 31 DDD/1000 PD in 2020. At SGHUMC, existing epidemics were not worsened by the pandemic. We attribute this to our unique and dynamic collaboration of antimicrobial stewardship, infection prevention and control, and infectious disease consultation. Full article
(This article belongs to the Special Issue Impact of Pandemic of COVID-19 on Antibiotic Prescription/Sales and on Antibiotic Resistances)
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13 pages, 1417 KiB  
Article
Surveillance of Antibacterial Usage during the COVID-19 Pandemic in England, 2020
by Amelia Andrews, Emma L. Budd, Aoife Hendrick, Diane Ashiru-Oredope, Elizabeth Beech, Susan Hopkins, Sarah Gerver, Berit Muller-Pebody and the AMU COVID-19 Stakeholder Group
Antibiotics 2021, 10(7), 841; https://doi.org/10.3390/antibiotics10070841 - 10 Jul 2021
Cited by 45 | Viewed by 6313
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 [...] Read more.
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. Full article
(This article belongs to the Special Issue Impact of Pandemic of COVID-19 on Antibiotic Prescription/Sales and on Antibiotic Resistances)
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Review

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14 pages, 973 KiB  
Review
Antimicrobial Use in COVID-19 Patients in the First Phase of the SARS-CoV-2 Pandemic: A Scoping Review
by Wenjuan Cong, Ak Narayan Poudel, Nour Alhusein, Hexing Wang, Guiqing Yao and Helen Lambert
Antibiotics 2021, 10(6), 745; https://doi.org/10.3390/antibiotics10060745 - 19 Jun 2021
Cited by 44 | Viewed by 6249
Abstract
This scoping review provides new evidence on the prevalence and patterns of global antimicrobial use in the treatment of COVID-19 patients; identifies the most commonly used antibiotics and clinical scenarios associated with antibiotic prescribing in the first phase of the pandemic; and explores [...] Read more.
This scoping review provides new evidence on the prevalence and patterns of global antimicrobial use in the treatment of COVID-19 patients; identifies the most commonly used antibiotics and clinical scenarios associated with antibiotic prescribing in the first phase of the pandemic; and explores the impact of documented antibiotic prescribing on treatment outcomes in COVID-19 patients. The review complies with PRISMA guidelines for Scoping Reviews and the protocol is registered with the Open Science Framework. In the first six months of the pandemic, there was a similar mean antibiotic prescribing rate between patients with severe or critical illness (75.4%) and patients with mild or moderate illness (75.1%). The proportion of patients prescribed antibiotics without clinical justification was 51.5% vs. 41.9% for patients with mild or moderate illness and those with severe or critical illness. Comparison of patients who were provided antibiotics with a clinical justification with those who were given antibiotics without clinical justification showed lower mortality rates (9.5% vs. 13.1%), higher discharge rates (80.9% vs. 69.3%), and shorter length of hospital stay (9.3 days vs. 12.2 days). In the first 6 months of the pandemic, antibiotics were prescribed for COVID-19 patients regardless of severity of illness. A large proportion of antibiotic prescribing for mild and moderate COVID-19 patients did not have clinical evidence of a bacterial co-infection. Antibiotics may not be beneficial to COVID-19 patients without clinical evidence of a bacterial co-infection. Full article
(This article belongs to the Special Issue Impact of Pandemic of COVID-19 on Antibiotic Prescription/Sales and on Antibiotic Resistances)
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