2273. Azithromycin Use Before and During COVID- 19 and Impact of Implementing Evidence-based Guidelines

Abstract

Abstract Background Early in the COVID-19 pandemic, results from small uncontrolled studies led to azithromycin being proposed as an effective treatment in patients with COVID-19. Numerous subsequent randomized controlled trials and observational studies have failed to demonstrate azithromycin’s effectiveness in COVID-19. The magnitude of azithromycin overuse, particularly for COVID-19 remains undocumented. We sought to quantify the use of azithromycin before and during the COVID-19 pandemic in a national healthcare system where specific evidence-based guidelines were rapidly implemented for judicious use of various suggested COVID-19 treatments. Methods The study was conducted at Hamad Medical Corporation in Qatar, which was the single provider of inpatient care for COVID-19 in Qatar. Evidence-based guidelines were implemented in Qatar for use of azithromycin in June 2020. For our study, all azithromycin prescriptions between 2019-2022 were retrieved from the electronic medical records. Number of azithromycin courses prescribed, and rate/100,000 population were calculated and compared over time. A course was defined as any azithromycin prescription with no gap of > 10 days. A course was deemed related to COVID-19 if written within -3 to +10 days of a positive SARS-CoV-2 PCR. A one-way repeated measured analysis of variance was conducted to evaluate the null hypothesis that there was no change in azithromycin use before and during COVID-19. Results During the study period, a total of 203,806 azithromycin courses were prescribed for 166,062 individuals. Overall number of courses increased in the first 2 quarters of 2020 (average 12,857/quarter in 2019 to average of 19,297 in Q1-Q2 of 2020) and then dropped precipitously to 9,881/quarter over the next 6 quarters. COVID-19 related azithromycin courses peaked in 2020-Q2 (13,691) and dropped subsequently to 2,836 for 2020-Q3, 1,410 for 2020-Q4; 5,465 for 2021-Q1, and 4,288 for 2021-Q2. Stringent evidence-based guidelines implemented in June 2020 for use of various COVID-19 therapeutics coincided with the rapid drop in azithromycin use for COVID-19. Conclusion While azithromycin prescriptions increased immediately after the COVID-19 pandemic, a rapid decline was observed immediately after implementing evidence-based guidelines Disclosures Adeel A. Butt, MBBS, MS, Gilead Sciences: Grant/Research Support|Merck and Company: Grant/Research Support