Does COVID-19 Pandemic Impacted on Quality of Antibiotic Use in the Community? An Interrupted Time-series Analysis

Background: COVID-19 pandemic has limited access to healthcare and also impacted drug use by populations. Additionally, the periods of lockdown imposed and other non-pharmaceutical measures may have impacted the transmission and spread of other infectious diseases.

Objectives: The aim of this study was to evaluate the impact of the COVID-19 pandemic on the quality of antibiotic use in the community.

Methods: A before-after, quasi-experimental approach was performed, using interrupted time series analysis adjusted with autoregressive integrated moving average (ARIMA) model, of the antibacterials for systemic use, from January 1st, 2016, to December 31st, 2021, in Portugal.
Outcome measures were the quality indications as described by Coenen S et al (2007):
· Absolute consumption of antibacterials for systemic use (J01), penicillins (J01C), cephalosporins (J01D), macrolides, lincosamides and streptogramins (J01F) and quinolones (J01M), expressed in DID (Defined Daily Doses per 1000 inhabitants per day).
· Relative consumption of beta-lactamase sensitive penicillins (J01CE), penicillins including beta-lactamase inhibitor (J01CR), third- and fourth generation cephalosporins (J01(DD+DE), fluoroquinolones (J01MA), as a percentage of the total consumption of antibacterials for systemic use (J01).
· Ratio of the consumption of broad-spectrum to narrow-spectrum penicillins, cephalosporins and macrolides (J01_B/N)

Results: Significant immediate changes in the absolute consumption of all indicators were found: antibacterials for systemic use (-4.94 DID), penicillins (-2.89 DID), cephalosporins (-0.42 DID), macrolides, lincosamides and streptogramins (-0.78 DID) and quinolones (-0.24 DID). Simultaneously, no significant changes were found in long-term trends of these indicators, except on the consumption of macrolides, lincosamides and streptogramins (-0.016 DID per month). Regarding relative consumption indicators, changes were found in the long-term use of beta-lactamase sensitive penicillins (-5.6E-4% per month) and the immediate use of third- and fourth generation cephalosporins 0.07%).

Conclusions: COVID-19 pandemic had a huge impact on antibiotic use in outpatient settings. Periods of lockdown, the use of face masks and hand sanitiser, the limited access to healthcare providers and the reduction in the transmission of other respiratory infections, may have reduced antibiotic consumption. Further research is needed to understand the consequences of these changes both in terms of public health and regarding the emergence of antimicrobial resistances.