(256) The Impact of the COVID-19 Pandemic on The Duration of Antibiotic Therapy Across Hospitals in Scotland: A Segmented Interrupted Time Series Analysis

Publication Number: 930

Background: Evidence, including aggregated-level data from Scotland, shows an association between COVID-19 and increased antibiotic use worldwide; however, it is unclear whether duration of antibiotic therapy has been affected by COVID-19

Objectives: To assess the impact of COVID-19 on the duration of amoxicillin and co-amoxiclav (the two most commonly used antibiotics for treating respiratory tract infections) therapy

Methods: A repeated, cross-sectional study was conducted using individual-level data from the Hospital Electronic Prescribing and Administration System (HEPMA) from six health boards (HBs) in Scotland (>80% of the Scottish population) from January 2019 to March 2022 [pre-COVID-19 period (Jan-2019 to Feb.2020), post-COVID-19 period (April-2020 to March 2022)]. The timeframe for HEPMA implementation across the included six HBs was varied. Segmented time-series analysis was applied to the monthly median duration of therapy and proportion of prescriptions with >7 days duration, stratified by route of administration (oral, IV and Both oral/IV), age and sex.

Results: During the study period, there were 73,311 and 55,693 prescriptions for amoxicillin and co-amoxiclav. For amoxicillin, overall median duration of therapy for oral, IV and Both were 2.4 (IQR: 1.4, 8), 1.4 (IQR: 1, 3), and 5.2 (IQR: 3.2, 6.8) days, respectively; whereas for co-amoxiclav it was 1.7 (IQR: 1, 4.4), 1 (IQR:1, 1.6) and 5.1 (IQR: 2.8, 7) days. For amoxicillin, COVID-19 was associated with statistical significant changes only for the IV route among those aged 50-60 (post-COVID-19 trend: -0.04; 95%CI: -0.08, -0.01), >80 years (post-COVID-19 trend: -0.02, 95%CI: -0.04, -0.001), and those received “Both” oral/IV (level: 0.4, 95%CI: 0.01, 0.8; post-COVID-19 trend: 0.05, 95%CI: 0.01, 0.09), particularly among those aged 40-50 years (post-COVID-19 trend: 0.2, 95%CI: 0.04, 0.30). For co-amoxiclav, there was a significant increase in the post-COVID-19 trend only for the oral route among patients ages 50-60 years (0.05, 95%CI: 0.01, 0.09). For the proportion of prescriptions with >7 days duration, a significant effect was observed only for IV co-amoxiclav (level: -1.1, 95%CI: -1.9, -0.3; post-COVID-19 trend: -0.1, 95%CI: -0.2, -0.05).

Conclusions: Although COVID-19 was found to have statistically significant effects on some of the study outcomes, these effects are unlikely to be clinically significant. This is encouraging compared to the increasing effect of COVID-19 on antibiotic use shown from the literature