Antibiotic prescribing in pediatric practices declined 73% amid pandemic
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Researchers observed a significant reduction in antibiotic prescriptions among pediatric primary care centers within the Children’s Hospital of Philadelphia network after the start of the COVID-19 pandemic.
Lauren Dutcher, MD, an instructor of medicine at the University of Pennsylvania School of Medicine, said this reduction was primarily due to a decline in prescriptions during encounters for respiratory tract infections (RTIs). She presented the findings during the virtual IDWeek meeting.
Dutcher and colleagues conducted a retrospective cohort study to investigate the impact of the COVID-19 pandemic, including the associated public health measures and changes in health care delivery, on antibiotic prescribing in 27 practices.
The researchers compared antibiotic prescribing trends from April 2019 through December 2019 with trends during the same period in 2020. They reported that total antibiotic prescriptions declined 73%, from 69,327 prescriptions in 2019 to 18,935 prescriptions in 2020. A reduction in prescriptions during RTI encounters accounted for 87.3% of the overall reduction in total antibiotic prescriptions, Dutcher said. During these encounters, antibiotic prescriptions declined from 50,876 in 2019 to 6,890 in 2020.
“I suspect that is likely in large part due to a reduction in circulating viral respiratory infections rather than a reduction in health care-seeking behavior,” Dutcher said. “We did see a reduction in health care-seeking behavior initially, as evidenced by an immediate and substantial decrease in overall visit volume, but when we saw the visit volume start to return to baseline relatively quickly, we did not see that in RTI-specific visits, suggesting that circulating RTIs remained low.”
The researchers estimated that there were 35.7 antibiotic prescriptions per 1,000 patients in April 2019 compared with 8.1 antibiotic prescriptions per 1,000 patients in April 2020 (77% reduction) and 8.8 antibiotic prescriptions per 1,000 patients in April 2021 (75% reduction). The researchers identified similar trends during RTI encounters. In contrast, prescription trends during encounters for UTIs and skin and soft tissue infections remained “relatively flat, even after the onset of the pandemic,” Dutcher said. Total antibiotic prescriptions appeared to increase in May and June of this year, she added.
“We saw that a minority of prescriptions were prescribed at telemedicine visits during the pandemic,” Dutcher said. “This is important because there is some literature to suggest that in primary care as well as in urgent care settings, there can sometimes be increased prescribing, specifically increased inappropriate prescribing, with telemedicine. But there wasn’t an outsize representation of telemedicine visits in our study.”
Perspective
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Gary C. Steven, MD, PhD, CPI, FAAAAI, FACAAI, FAPCR
Interestingly, my anecdotal experience is remarkably similar — a 72% reduction in antibiotic prescriptions for RTI in the first full year of the pandemic (April 1, 2020, to April 1, 2021) compared to the average for the previous 5 years. In contrast to this much larger pediatric study, I see both children and adults in my solo, independent, community-based allergy practice. However, rather than ascribing the reduction to a decrease in encounters, the reduction in antibiotics for RTIs was much more likely due to nonpharmacologic mitigation measures such as masking and distancing, since my number of patient encounters did not decrease. In order to encourage allergen immunotherapy and asthma biologic patients to stay on therapy, we strove to keep the waiting room empty by scheduling injection appointments rather than allowing walk-ins and pivoting rapidly to telemedicine. I have conducted over 5,100 televisits since the start of the pandemic, an increase of approximately 3% in total patient volume. I attribute this to the ease with which patients can participate in televisits, as well as the drastically reduced no-show rate; less than 10% of my in-person no-show rate, which sometimes reached as high as 20% in a day.
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Dutcher L, et al. Abstract 162. Presented at: IDWeek;Sept. 29-Oct. 3, 2021 (virtual meeting).
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