Azithromycin consumption during the COVID-19 pandemic in Croatia, 2020.

Nikolina Bogdanić,Toni Vidović,Loris Močibob,Josip Begovać,Ana Soldo,Iddya Karunasagar

doi:10.1371/journal.pone.0263437

Nikolina Bogdanić, Toni Vidović + Show 4 more

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https://doi.org/10.1371/journal.pone.0263437

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Abstract

During the initial phase of the COVID-19 pandemic, there was great enthusiasm for the use of azithromycin with or without hydroxychloroquine. We analyzed azithromycin consumption in Croatia in 2020 and compared this to the period 2017-2019. Azithromycin consumption was evaluated using the IQVIA Adriatic d.o.o. database which collects data on azithromycin distribution from wholesale pharmacies to hospital and non-hospital pharmacies in Croatia. We analyzed data for the period from January 2017 to December 2020. Azithromycin distribution was measured as days of therapy (DOT) and reported as per 1000 inhabitants or per 1000 inhabitant-days. In the period 2017-2020, total azithromycin DOT in Croatia increased in 2017, 2018, 2019, and 2020 (1.76, 1.91, 1.91 and 2.01/1000 inhabitant-days, respectively). Non-hospital pharmacies received 2.18 times and hospital pharmacies 4.39 times more DOT units/1000 inhabitants of azithromycin in March 2020 compared to the average distribution rate in March 2017-2019. During the peak of the COVID-19 epidemic (November and December 2020) azithromycin distribution increased considerably in hospital (3.62 and 3.19 times, respectively) and non-hospital pharmacies (1.93 and 1.84 times, respectively) compared to the average consumption in the same months in 2017-2019. Our data showed increased azithromycin distribution in the period 2017-2020 which indicates azithromycin overuse. Preliminary information on COVID-19 treatments with a desire to offer and try what is available even in the absence of strong scientific evidence may have influenced practices of antimicrobial prescriptions.

Highlights

Since the beginning of the COVID-19 pandemic concerns about the potential consequences of antimicrobial overuse have been raised [1]
Non-hospital pharmacies received 2.18 times and hospital pharmacies 4.39 times more days of therapy (DOT) units/1000 inhabitants of azithromycin in March 2020 compared to the average distribution rate in March 2017–2019
An international survey among physicians involved in the treatment of COVID-19 patients on antibiotic prescribing practices conducted in April 2020 revealed that the decision on antibiotic use was mostly based on clinical presentation, with the need for coverage of atypical pathogens and more than half of the participants reported use of a combination of β-lactams and macrolides or fluoroquinolones [2]

Summary

Introduction

Since the beginning of the COVID-19 pandemic concerns about the potential consequences of antimicrobial overuse have been raised [1]. The use of azithromycin with hydroxychloroquine gained much attention when preliminary observational reports and non-randomized pilot studies indicated favorable outcomes in patients treated with this combination [4, 5]. During the initial phase of the COVID-19 pandemic, there was great enthusiasm for the use of azithromycin with or without hydroxychloroquine. Peer Review History: PLOS recognizes the benefits of transparency in the peer review process; we enable the publication of all of the content of peer review and author responses alongside final, published articles.

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