Restrictions to help prevent the spread of COVID-19 have seen antibiotic prescription rates plunge
A new study led by a team of researchers at UNSW Sydney and the Murdoch Children’s Research Institute has examined the impact of COVID-19 restrictions on antibiotic dispensing in Australia.
The study – published in the British Journal of Clinical Pharmacology – revealed a 36% drop in antibiotic prescription rates following the COVID-19 restrictions despite stable rates of GP consultations.
Australia is in the top quarter of high-income countries for antibiotic use, the researchers note.
Inappropriate prescribing for viral upper and lower respiratory tract infections has been estimated to account for 40% of antibiotics prescribed by Australian GPs.
Antibiotic prescribing contrary to clinical guidelines is a problem in both hospitals and the community in many countries and is a major driver of antimicrobial resistance, they say.
The researchers observed the drop in antibiotic dispensing continued into winter, a contrast to the seasonality of antibiotic prescribing before the pandemic.
During the period observed by the research team (April – October 2020), similar reductions were recorded across all age groups, with no corresponding change in GP consultations over time.
They also noted that while from April 2020 31% of GP consultations were via telehealth, GP consultation rates actually remained stable. This suggested the large declines in antibiotic use were unlikely due to reduced access to health care, they said.
The researchers used national claims data to investigate antibiotic dispensing trends from November 2015 through the pandemic period studied of April-October 2020.
“We used interrupted time series analysis to quantify changes in monthly antibiotic dispensing and face-to-face and telehealth GP consultations and examined changes by recipient age, pharmacy State and prescriber specialty,” they wrote.
Over the entire study period, an estimated 19,921,370 people had 125,495,137 antibiotic dispensings.
Of these, 71% were prescribed by GPs.
But following the introduction of COVID-19 restrictions, the researchers observed a sustained (95% CI: 33-40%) reduction in antibiotic dispensings, from April 2020.
“Antibiotics recommended for managing respiratory tract infections showed large reductions (range 51–69%), whereas those recommended for non-respiratory infections were unchanged,” they wrote.
“Other sources of data showed rates of respiratory infections in the community fell in this period and that is likely the reason for the decline in antibiotic use,” said lead author of the report, Dr Malcolm Gillies from UNSW.
“We believe that our findings are informative for post-pandemic antimicrobial stewardship and highlight the potential to reduce inappropriate prescribing for respiratory viral infections.”
A/Prof Helga Zoega from UNSW and a senior author of the paper said similar changes in antibiotic use happened around the world.
“However, this is the first data we know of from a country where rates of COVID-19 infection were low,” she said.
“The reductions observed in our study occurred during winter months (June– August) when antibiotic prescribing is normally at its highest, and they were seen across all age groups and jurisdictions despite differing levels of COVID-19 restrictions.”
The researchers said there have been efforts to reduce unnecessary antibiotic use in Australia, but it is slow and difficult work.
“There is a significant body of research on what interventions are effective, and we need to keep at it,” said Dr Gillies.
Professor David Burgner from the Murdoch Children’s Research Institute said, “Although most of the current focus is understandably on the pandemic, the issue of antibiotic resistance remains a public health priority both nationally and globally and one we can’t afford to put on hold. A key element is ensuring we use antibiotics as judiciously as possible.”
The researchers say they hope the decreased use of antibiotics observed across Australia and several countries during the COVID-19 pandemic will help target reductions in unwarranted prescribing in a post-pandemic era.