Abstract
IntroductionRecent reports have highlighted the impact of the COVID-19 pandemic on the incidence of infectious disease illnesses and antibiotic use. This study investigates the effect of the pandemic on childhood incidence of otitis media (OM) and associated antibiotic prescribing in a large primary care-based cohort in the Netherlands.Material and MethodsRetrospective observational cohort study using routine health care data from the Julius General Practitioners’ Network (JGPN). All children aged 0-12 registered in 62 practices before the COVID-19 pandemic (1 March 2019 - 29 February 2020) and/or during the pandemic (1 March 2020 - 28 February 2021) were included. Data on acute otitis media (AOM), otitis media with effusion (OME), ear discharge episodes and associated antibiotic prescriptions were extracted. Incidence rates per 1,000 child years (IR), incidence rate ratios (IRR) and incidence rate differences (IRD) were compared between the two study periods.ResultsOM episodes declined considerably during the COVID-19 pandemic: IR pre-COVID-19 vs COVID-19 for AOM 73.7 vs 27.1 [IRR 0.37]; for OME 9.6 vs 4.1 [IRR 0.43]; and for ear discharge 12.6 vs 5.8 [IRR 0.46]. The absolute number of AOM episodes in which oral antibiotics were prescribed declined accordingly (IRD pre-COVID-19 vs COVID-19: -22.4 per 1,000 child years), but the proportion of AOM episodes with antibiotic prescription was similar in both periods (47% vs 46%, respectively).DiscussionGP consultation for AOM, OME and ear discharge declined by 63%, 57% and 54% respectively in the Netherlands during the COVID-19 pandemic. Similar antibiotic prescription rates before and during the pandemic indicate that the case-mix presenting to primary care did not considerably change. Our data therefore suggest a true decline as a consequence of infection control measures introduced during the pandemic.
Highlights
Recent reports have highlighted the impact of the COVID-19 pandemic on the incidence of infectious disease illnesses and antibiotic use
Similar to the overall otitis media (OM) episodes, the absolute number of acute otitis media (AOM) episodes in which oral antibiotics were prescribed declined (IRD pre-COVID-19 vs COVID-19: -22.4 per 1,000 child years), but the proportion of AOM episodes with antibiotic prescription was similar in both periods (47% vs 46%, respectively) (Table 1)
OM episodes declined considerably during the COVID-19 pandemic (Table 1).The Incidence rates (IR) per 1,000 child-years pre-COVID19 vs COVID-19 for AOM were 73.7 vs 27.1 [IRR 0.37, 95% confidence intervals (CI) 0.35-0.39], for otitis media with effusion (OME) 9.6 vs 4.1 [IRR 0.43, 95% CI 0.37-0.49], for ear discharge 12.6 vs IR 5.8 [IRR 0.46, 95% CI 0.41-0.52] and for ear pain 18.1 vs 11.8 [IRR 0.65, 95% CI 0.60-0.71]
Summary
Recent reports have highlighted the impact of the COVID-19 pandemic on the incidence of infectious disease illnesses and antibiotic use. This study investigates the effect of the pandemic on childhood incidence of otitis media (OM) and associated antibiotic prescribing in a large primary care-based cohort in the Netherlands. The question is whether the infection control measures or the sudden COVID-19 related changes in health care access and delivery are responsible for these changes We will address this question by investigating the effect of the COVID-19 pandemic on OM consultations and associated antibiotic prescribing in children in a large primary care cohort in the Netherlands where the general practitioner (GP) is the first point of call (Grobbee et al, 2005) for the management of OM for all children and practices could be contacted for medical advice throughout the pandemic
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