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.
Bibliographical noteFunding Information:
This research was carried out as enhanced surveillance of Public Health England?s routine work. S.H., A.A., S.G., and B.M.-P. are partly funded by the National Institute for Health Research (NIHR) Health Protection Research Unit (HPRU) in Healthcare-Associated Infections and Antimi-crobial Resistance in a partnership between Public Health England (PHE) and (i) Imperial College London [NIHR200876] and (ii) the University of Oxford [NIHR200915]. Members of the Antimicrobial Usage (AMU) COVID-19 Stakeholder Group: Alicia Demirjian, Anna Sallis, Colin Brown, Cliodna McNulty, David Ladenheim, Donna Lecky, Elizabeth Johnson, Jake Dunning, Martin Llewelyn, Musarrat Afza, Natalie Gold, Peter Wilson, Philip Howard, Sally Weston-Price, and Sandra White. We would like to thank the AMU COVID-19 Stakeholder Group for providing feedback on the protocol and manuscript. We would also like to thank Ross Harris for providing statistical advice, Rebecca Guy and Sabine Bou-Antoun for providing feedback on the project, and Ella Casale for minuting the Stakeholder Group Meetings.
Funding: This research was carried out as enhanced surveillance of Public Health England’s routine work. S.H., A.A., S.G., and B.M.-P. are partly funded by the National Institute for Health Research (NIHR) Health Protection Research Unit (HPRU) in Healthcare-Associated Infections and Antimicrobial Resistance in a partnership between Public Health England (PHE) and (i) Imperial College London [NIHR200876] and (ii) the University of Oxford [NIHR200915].
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- Antimicrobial stewardship