Impact of the COVID-19 Pandemic on Community Antibiotic Prescribing and Stewardship: A Qualitative Interview Study with General Practitioners in England.

Aleksandra J Borek,Katherine Maitland,Laurence S J Roope,Anne Campbell,Benedict Hayhoe,Alison Holmes,Sarah Tonkin-Crine,Liz Morrell,Monsey Mcleod,Christopher C Butler,Ann Sarah Walker

doi:10.3390/antibiotics10121531

Abstract

The COVID-19 pandemic has had a profound impact on the delivery of primary care services. We aimed to identify general practitioners’ (GPs’) perceptions and experiences of how the COVID-19 pandemic influenced antibiotic prescribing and antimicrobial stewardship (AMS) in general practice in England. Twenty-four semi-structured interviews were conducted with 18 GPs at two time-points: autumn 2020 (14 interviews) and spring 2021 (10 interviews). Interviews were audio-recorded, transcribed and analysed thematically, taking a longitudinal approach. Participants reported a lower threshold for antibiotic prescribing (and fewer consultations) for respiratory infections and COVID-19 symptoms early in the pandemic, then returning to more usual (pre-pandemic) prescribing. They perceived the pandemic as having had less impact on antibiotic prescribing for urinary and skin infections. Participants perceived the changing ways of working and consulting (e.g., proportions of remote and in-person consultations) in addition to changing patient presentations and GP workloads as influencing the fluctuations in antibiotic prescribing. This was compounded by decreased engagement with, and priority of, AMS due to COVID-19-related urgent priorities. Re-engagement with AMS is needed, e.g., through reviving antibiotic prescribing feedback and targets/incentives. The pandemic disrupted, and required adaptations in, the usual ways of working and AMS. It is now important to identify opportunities, e.g., for re-organising ways of managing infections and AMS in the future.

Highlights

Antimicrobial stewardship (AMS), including optimising antibiotic prescribing and use, is a public health priority designed to mitigate the development and impact of antimicrobial resistance [1,2]
After this we stopped recruitment as we considered the data sufficient to answer the research question and develop rich categories and themes supported by multiple data extracts from different participants
There were mixed views: Some participants described no change in their communication with patients during the pandemic and remote consultations

Summary

Introduction

Antimicrobial stewardship (AMS), including optimising antibiotic prescribing and use, is a public health priority designed to mitigate the development and impact of antimicrobial resistance [1,2]. International studies have shown that the majority of patients admitted to hospitals with COVID-19 were prescribed empirical antibiotics despite a low prevalence of bacterial co-infection and regardless of illness severity [4,5,6,7,8]. Concerns were raised about the impact of COVID-19 on antimicrobial prescribing, AMS and future consequences for antimicrobial resistance, health and the environment, with calls to keep AMS as a priority [10,11,12,13,14,15,16,17]

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Conclusion