Abstract
In 2020, the COVID-19 pandemic brought dramatic changes in the delivery of primary health care across the world, presumably changing the number of consultations for infectious diseases and antibiotic use. We aimed to assess the impact of the pandemic on infections and antibiotic prescribing in Dutch primary care. All patients included in the routine health care database of the Julius General Practitioners’ Network were followed from March through May 2019 (n = 389,708) and March through May 2020 (n = 405,688). We extracted data on consultations for respiratory/ear, urinary tract, gastrointestinal and skin infections using the International Classification of Primary Care (ICPC) codes. These consultations were combined in disease episodes and linked to antibiotic prescriptions. The numbers of infectious disease episodes (total and those treated with antibiotics), complications, and antibiotic prescription rates (i.e., proportion of episodes treated with antibiotics) were calculated and compared between the study periods in 2019 and 2020. Fewer episodes were observed during the pandemic months than in the same months in 2019 for both the four infectious disease entities and complications such as pneumonia, mastoiditis and pyelonephritis. The largest decline was seen for gastrointestinal infections (relative risk (RR), 0.54; confidence interval (CI), 0.51 to 0.58) and skin infections (RR, 0.71; CI, 0.67 to 0.75). The number of episodes treated with antibiotics declined as well, with the largest decrease seen for respiratory/ear infections (RR, 0.54; CI, 0.52 to 0.58). The antibiotic prescription rate for respiratory/ear infections declined from 21% to 13% (difference −8.0% (CI, −8.8 to −7.2)), yet the prescription rates for other infectious disease entities remained similar or increased slightly. The decreases in primary care infectious disease episodes and antibiotic use were most pronounced in weeks 15–19, mid-COVID-19 wave, after an initial peak in respiratory/ear infection presentation in week 11, the first week of lock-down. In conclusion, our findings indicate that the COVID-19 pandemic has had profound effects on the presentation of infectious disease episodes and antibiotic use in primary care in the Netherlands. Consequently, the number of infectious disease episodes treated with antibiotics decreased. We found no evidence of an increase in complications.
Highlights
The COVID-19 pandemic has brought dramatic changes in the delivery of primary health care, especially for patients with respiratory tract infections [1,2]
We found no evidence of an increase in complications such as pneumonia, mastoiditis, or pyelonephritis
Contrary to the results of our study, where we found a decrease in the number of infection episodes for which antibiotics were prescribed, in UK primary care an unexpectedly high rate of antibiotic prescribing was observed during the COVID-19 pandemic [8]
Summary
The COVID-19 pandemic has brought dramatic changes in the delivery of primary health care, especially for patients with respiratory tract infections [1,2]. It has been suggested that virtual assessments limit diagnostic capabilities and could thereby result in overprescribing of antibiotics [3,4] The latter is of particular concern, since this has been recognized as the main driver of antimicrobial resistance [5,6]. GPs may have lowered their antibiotic prescribing threshold as a result of diagnostic uncertainty during remote consultation and to prevent adverse outcomes whilst there is limited hospital capacity. Patients may have been less inclined to consult their GP (as a result of advice to stay away from general practices and self-manage uncomplicated infectious conditions), and GPs may have more frequently perceived respiratory tract infections as being of viral origin, without a need for antibiotics, due to the introduction of SARS-CoV-2
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