Abstract
Coronavirus disease 2019 (COVID-19) has spread globally and is currently having a damaging impact on nearly all countries in the world. The implementation of stringent measures to stop COVID-19 dissemination had an influence on healthcare services and associated procedures, possibly causing antibiotic consumption fluctuations. This paper aims to evaluate the immediate and long-term impact of the COVID-19 pandemic on antibiotic prescribing trends in outpatient care of the Portuguese public health sector, including in primary healthcare centers and hospitals, as well as on specific antibiotic groups known to be closely associated with increased resistance. Segmented regression analysis with interrupted time series data was used to analyze whether the COVID-19 pandemic had an impact in antibiotic prescribing tendencies at a national level. The outcomes from this quasi-experimental approach demonstrate that, at the beginning of the pandemic, a significant, immediate decrease in the overall antibiotic prescribing trends was noticed in the context of outpatient care in Portugal, followed by a statistically non-significant fall over the long term. The data also showed a significant reduction in the prescription of particular antibiotic classes (antibiotics from the Watch group, 3rd-generation cephalosporins, fluoroquinolones, and clarithromycin) upon COVID-19 emergence. These findings revealed an important disruption in antibiotics prescribing caused by the current public health emergency.
Highlights
The coronavirus disease 2019 (COVID-19) outbreak has quickly emerged as a public health emergency worldwide, with countries gathering all their efforts to combat this dangerous threat [1]
The World Health Organization (WHO)’s recommendations for patients with mild or moderate COVID-19 are against the prescription of antibiotic therapy, unless there is a clinical suspicion of a bacterial infection or co-infection, this practice was shown to be common within hospitals [8,9,10,11,12]
To the best of our knowledge, this is the first study highlighting the significant impact caused by the COVID-19 pandemic and related population-imposed measures on the antibiotic prescribing trends in outpatient care, from a nationwide point of view
Summary
The coronavirus disease 2019 (COVID-19) outbreak has quickly emerged as a public health emergency worldwide, with countries gathering all their efforts to combat this dangerous threat [1]. By 6 May 2021, there were approximately 838 thousand infections in Portugal and nearly 17 thousand deaths due to COVID-19 [7]. As a response to the quick escalation in the number of COVID-19 infections, a clinical guidance document for managing COVID-19 patients during all stages of the disease was published by the WHO [8]. The WHO’s recommendations for patients with mild or moderate COVID-19 are against the prescription of antibiotic therapy, unless there is a clinical suspicion of a bacterial infection or co-infection, this practice was shown to be common within hospitals [8,9,10,11,12]. Various studies have shown that some antibiotics were used to treat COVID-19 inpatients as a combination (e.g., azithromycin used in combination with other drugs due to its immunomodulatory effect [13,14]) or alternative therapies [15,16]
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