Surveillance of Antibacterial Usage during the COVID-19 Pandemic in England, 2020.

Amelia Andrews,Sarah Gerver,Elizabeth Beech,Aoife Hendrick,Berit Muller-Pebody,Susan Hopkins,Emma L Budd,Diane Ashiru-Oredope,The Amu Covid-Stakeholder Group The Amu Covid-Stakeholder Group

doi:10.3390/antibiotics10070841

Abstract

Changes in antibacterial prescribing during the COVID-19 pandemic were anticipated given that the clinical features of severe respiratory infection syndrome caused by SARS-CoV-2 mirror bacterial respiratory tract infections. Antibacterial consumption was measured in items/1000 population for primary care and in Defined Daily Doses (DDDs)/1000 admissions for secondary care in England from 2015 to October 2020. Interrupted time-series analyses were conducted to evaluate the effects of the pandemic on antibacterial consumption. In the community, the rate of antibacterial items prescribed decreased further in 2020 (by an extra 1.4% per month, 95% CI: −2.3 to −0.5) compared to before COVID-19. In hospitals, the volume of antibacterial use decreased during COVID-19 overall (−12.1% compared to pre-COVID, 95% CI: −19.1 to −4.4), although the rate of usage in hospitals increased steeply in April 2020. Use of antibacterials prescribed for respiratory infections and broad-spectrum antibacterials (predominately ‘Watch’ antibacterials in hospitals) increased in both settings. Overall volumes of antibacterial use at the beginning of the COVID-19 pandemic decreased in both primary and secondary settings, although there were increases in the rate of usage in hospitals in April 2020 and in specific antibacterials. This highlights the importance of antimicrobial stewardship during pandemics to ensure appropriate prescribing and avoid negative consequences on patient outcomes and antimicrobial resistance.

Highlights

In March 2020, the World Health Organization (WHO) declared the outbreak caused by the novel coronavirus SARS-CoV-2 a pandemic [1]
We aim to describe the impact of the COVID-19 pandemic on antibacterial prescribing across primary and secondary care in England between January and October 2020, to inform antimicrobial stewardship activities during the ongoing COVID-19 challenges and future pandemic preparations
Oral amoxicillin and oral doxycycline were recommended as first-choice treatments in the pre-COVID National Institute for Clinical Excellence (NICE) community-acquired pneumonia guideline [31], and the usage of both antibacterials increased in March 2020 compared to March 2019

Summary

Introduction

In March 2020, the World Health Organization (WHO) declared the outbreak caused by the novel coronavirus SARS-CoV-2 a pandemic [1]. The high transmissibility of the virus and clinical severity of the associated coronavirus disease (COVID-19) have since challenged most aspects of healthcare delivery globally. This includes diagnosis, clinical management, and infection prevention and control measures related to COVID-19, and the effective delivery of antimicrobial stewardship, in early 2020 at the beginning of the pandemic [2]. Markers of infection such as C-reactive protein did not effectively distinguish between bacterial and viral pneumonia infections Such diagnostic challenges complicated the decision for clinicians as to whether to prescribe antibiotics empirically [7]

Objectives

Methods

Results

Conclusion