TY - JOUR
T1 - Impact of COVID-19 on broad-spectrum antibiotic prescribing for common infections in primary care in England: a time-series analyses using OpenSAFELY and effects of predictors including deprivation
AU - Zhong, Xiaomin
AU - Pate, Alexander
AU - Yang, Ya-Ting
AU - Fahmi, Ali
AU - Ashcroft, Darren
AU - Goldacre, Ben
AU - Mackenna, Brian
AU - Mehrkar, Amir
AU - Bacon, Sebastian CJ.
AU - Massey, Jon
AU - Fisher, Louis
AU - Inglesby, Peter
AU - OpenSAFELY collaborative
AU - Hand, Kieran
AU - Van Staa, Tjeerd
AU - Palin, Victoria
PY - 2023/7/1
Y1 - 2023/7/1
N2 - Background: The COVID-19 pandemic impacted the healthcare systems, adding extra pressure to reduce antimicrobial resistance. Therefore, we aimed to evaluate changes in antibiotic prescription patterns after COVID-19 started. Methods: With the approval of NHS England, we used the OpenSAFELY platform to access the TPP SystmOne electronic health record (EHR) system in primary care and selected patients prescribed antibiotics from 2019 to 2021. To evaluate the impact of COVID-19 on broad-spectrum antibiotic prescribing, we evaluated prescribing rates and its predictors and used interrupted time series analysis by fitting binomial logistic regression models. Findings: Over 32 million antibiotic prescriptions were extracted over the study period; 8.7% were broad-spectrum. The study showed increases in broad-spectrum antibiotic prescribing (odds ratio [OR] 1.37; 95% confidence interval [CI] 1.36–1.38) as an immediate impact of the pandemic, followed by a gradual recovery with a 1.1–1.2% decrease in odds of broad-spectrum prescription per month. The same pattern was found within subgroups defined by age, sex, region, ethnicity, and socioeconomic deprivation quintiles. More deprived patients were more likely to receive broad-spectrum antibiotics, which differences remained stable over time. The most significant increase in broad-spectrum prescribing was observed for lower respiratory tract infection (OR 2.33; 95% CI 2.1–2.50) and otitis media (OR 1.96; 95% CI 1.80–2.13). Interpretation: An immediate reduction in antibiotic prescribing and an increase in the proportion of broad-spectrum antibiotic prescribing in primary care was observed. The trends recovered to pre-pandemic levels, but the consequence of the COVID-19 pandemic on AMR needs further investigation. Funding: This work was supported by Health Data Research UK and by National Institute for Health Research.
AB - Background: The COVID-19 pandemic impacted the healthcare systems, adding extra pressure to reduce antimicrobial resistance. Therefore, we aimed to evaluate changes in antibiotic prescription patterns after COVID-19 started. Methods: With the approval of NHS England, we used the OpenSAFELY platform to access the TPP SystmOne electronic health record (EHR) system in primary care and selected patients prescribed antibiotics from 2019 to 2021. To evaluate the impact of COVID-19 on broad-spectrum antibiotic prescribing, we evaluated prescribing rates and its predictors and used interrupted time series analysis by fitting binomial logistic regression models. Findings: Over 32 million antibiotic prescriptions were extracted over the study period; 8.7% were broad-spectrum. The study showed increases in broad-spectrum antibiotic prescribing (odds ratio [OR] 1.37; 95% confidence interval [CI] 1.36–1.38) as an immediate impact of the pandemic, followed by a gradual recovery with a 1.1–1.2% decrease in odds of broad-spectrum prescription per month. The same pattern was found within subgroups defined by age, sex, region, ethnicity, and socioeconomic deprivation quintiles. More deprived patients were more likely to receive broad-spectrum antibiotics, which differences remained stable over time. The most significant increase in broad-spectrum prescribing was observed for lower respiratory tract infection (OR 2.33; 95% CI 2.1–2.50) and otitis media (OR 1.96; 95% CI 1.80–2.13). Interpretation: An immediate reduction in antibiotic prescribing and an increase in the proportion of broad-spectrum antibiotic prescribing in primary care was observed. The trends recovered to pre-pandemic levels, but the consequence of the COVID-19 pandemic on AMR needs further investigation. Funding: This work was supported by Health Data Research UK and by National Institute for Health Research.
KW - Antimicrobial resistance
KW - Broad-spectrum antibiotics
KW - COVID-19 pandemic
KW - Primary care
UR - http://www.scopus.com/inward/record.url?scp=85162209998&partnerID=8YFLogxK
UR - https://www.mendeley.com/catalogue/f1b360b5-9a86-355a-9266-1a03fecc24a9/
U2 - 10.1016/j.lanepe.2023.100653
DO - 10.1016/j.lanepe.2023.100653
M3 - Article
C2 - 37363797
SN - 2666-7762
VL - 30
JO - The Lancet Regional Health – Europe
JF - The Lancet Regional Health – Europe
M1 - 100653
ER -
