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January 07, 2021
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Fills for 10 most common antibiotics declined up to 56% in early days of pandemic

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Prescription fills for each of the 10 most prescribed outpatient antibiotics in the United States declined by up to 56% in April during the first peak of the COVID-19 pandemic, researchers found.

Fills for seven of the antibiotics rebounded by July. However, fills for azithromycin, amoxicillin-clavulanate and levofloxacin which are typically used for bacterial infections of the lower and upper respiratory tract did not return to seasonally adjusted, pre-pandemic levels.

Antibiotics
Prescription fills for the 10 most prescribed outpatient antibiotics in the United States dropped by 13% to 56% in April 2020 during the first peak of the COVID-19 pandemic.

Source: Adobe Stock

“We previously published a paper on the impact of COVID-19 on in-hospital antibiotic prescribing and stewardship at our health care system. We found significant decreases in overall antibiotic consumption in the first months of the pandemic but an increase in consumption per bed day of care,” Cornelius (Neil) J. Clancy, MD, associate professor of medicine and director of the extensively drug-resistant pathogen lab and mycology program at the University of Pittsburgh, told Healio.

“The impact of this usage on antimicrobial resistance remains unclear,” Clancy said. “Outpatient antibiotic use dwarfs that of in-hospital use, and it's a bigger driver of resistance within a given geographic region. We hypothesized that large drops in outpatient prescriptions in the early stages of the pandemic in the U.S. would be offset by later rebounds.”

Cornelius (Neil) J. Clancy

Clancy and colleagues obtained monthly prescription fill data for August 2014 through July 2020 from the IQVIA National Prescription Audit databases. According to the study, the researchers then used modelling to estimate changes in fills from August 2014 through March 2020 and April 2020 through July 2020, “controlling for previous trends and autocorrelation (seasonal effects).”

According to the study, which assessed monthly prescription fills per 1,000 people, there were significant decreases during the pre-pandemic period in fills for ciprofloxacin (P < .001), levofloxacin (P < .001), sulfamethoxazole-trimethoprim (P < .001) and clindamycin (P = .006), as well as significant increases in monthly fills per 1,000 people of doxycycline and nitrofurantoin (P < .001). No significant changes were observed for amoxicillin, azithromycin, amoxicillin-clavulanate or cephalexin.

In April, according to the study, monthly prescription fills per 1,000 people of all 10 antibiotics declined significantly, by at least 13% (for nitrofurantoin) and as much as 56% (for amoxicillin) (P < .001).

Then, from April through July, there were no significant changes in monthly prescription fills of azithromycin, amoxicillin-clavulanate or levofloxacin, whereas monthly fills of other antibiotics significantly increased during these months (P < .001), Clancy and colleagues reported.

“COVID-19 had immediate and sustained impact on use of outpatient antibiotics in the U.S., particularly of agents used to treat respiratory tract infections,” Clancy said. “The reasons for this are unclear but may reflect that patients were less likely to seek care for respiratory symptoms, clinicians were less likely to prescribe an antibiotic for respiratory symptoms, and/or preventive measures vs. COVID-19 resulted in fewer respiratory tract infections.”

“To the extent that unnecessary antibiotic prescribing may have decreased,” Clancy said, “the change in usage may provide a foundation upon which to build for stewardship. It will be important to understand reasons for prescribing behaviors and how patterns evolve over the late fall and winter COVID-19 surges in the U.S.”