COVID-19 and Outpatient Antibiotic Prescriptions in the United States: A County-Level Analysis.
antimicrobial stewardship
antibiotic resistance
behavioral norms
non-pharmaceutical interventions
respiratory infections
Journal
Open forum infectious diseases
ISSN: 2328-8957
Titre abrégé: Open Forum Infect Dis
Pays: United States
ID NLM: 101637045
Informations de publication
Date de publication:
Mar 2023
Mar 2023
Historique:
received:
17
11
2022
accepted:
20
02
2023
entrez:
23
3
2023
pubmed:
24
3
2023
medline:
24
3
2023
Statut:
epublish
Résumé
Declines in outpatient antibiotic prescribing were reported during the beginning of the coronavirus disease 2019 (COVID-19) pandemic in the United States; however, the overall impact of COVID-19 cases on antibiotic prescribing remains unclear. This was an ecological study using random-effects panel regression of monthly reported COVID-19 county case and antibiotic prescription data, controlling for seasonality, urbanicity, health care access, nonpharmaceutical interventions (NPIs), and sociodemographic factors. Antibiotic prescribing fell 26.8% in 2020 compared with prior years. Each 1% increase in county-level monthly COVID-19 cases was associated with a 0.009% (95% CI, 0.007% to 0.012%; The positive association of COVID-19 cases with prescribing for all ages and the negative association for children indicate that increases in prescribing occurred primarily among adults. The rarity of bacterial coinfection in COVID-19 patients suggests that a fraction of these prescriptions may have been inappropriate. Facemasks and school closures were correlated with reductions in prescribing among children, possibly due to the prevention of other upper respiratory infections. The strongest predictors of prescribing were prior years' prescribing trends, suggesting the possibility that behavioral norms are an important driver of prescribing practices.
Sections du résumé
Background
UNASSIGNED
Declines in outpatient antibiotic prescribing were reported during the beginning of the coronavirus disease 2019 (COVID-19) pandemic in the United States; however, the overall impact of COVID-19 cases on antibiotic prescribing remains unclear.
Methods
UNASSIGNED
This was an ecological study using random-effects panel regression of monthly reported COVID-19 county case and antibiotic prescription data, controlling for seasonality, urbanicity, health care access, nonpharmaceutical interventions (NPIs), and sociodemographic factors.
Results
UNASSIGNED
Antibiotic prescribing fell 26.8% in 2020 compared with prior years. Each 1% increase in county-level monthly COVID-19 cases was associated with a 0.009% (95% CI, 0.007% to 0.012%;
Conclusions
UNASSIGNED
The positive association of COVID-19 cases with prescribing for all ages and the negative association for children indicate that increases in prescribing occurred primarily among adults. The rarity of bacterial coinfection in COVID-19 patients suggests that a fraction of these prescriptions may have been inappropriate. Facemasks and school closures were correlated with reductions in prescribing among children, possibly due to the prevention of other upper respiratory infections. The strongest predictors of prescribing were prior years' prescribing trends, suggesting the possibility that behavioral norms are an important driver of prescribing practices.
Identifiants
pubmed: 36949878
doi: 10.1093/ofid/ofad096
pii: ofad096
pmc: PMC10026546
doi:
Types de publication
Journal Article
Langues
eng
Pagination
ofad096Informations de copyright
© The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America.
Déclaration de conflit d'intérêts
Potential conflicts of interest. All authors: no reported conflicts.
Références
J Med Virol. 2021 Jul;93(7):4099-4101
pubmed: 33760278
J Am Coll Surg. 2008 Aug;207(2):265-75
pubmed: 18656057
JAMA Intern Med. 2021 Oct 1;181(10):1399-1402
pubmed: 34152385
JAMA Netw Open. 2021 Sep 1;4(9):e2126114
pubmed: 34550387
JAMA. 2016 May 3;315(17):1864-73
pubmed: 27139059
Sci Rep. 2022 Oct 6;12(1):16729
pubmed: 36202875
J Glob Health. 2021 Jun 26;11:05015
pubmed: 34221360
Proc Natl Acad Sci U S A. 2011 Feb 15;108(7):2825-30
pubmed: 21282645
Open Forum Infect Dis. 2020 Dec 21;8(1):ofaa578
pubmed: 33447639
Nat Commun. 2021 May 18;12(1):2937
pubmed: 34006862
J Econ Behav Organ. 2021 Feb;182:311-330
pubmed: 33362321
Clin Infect Dis. 2021 May 18;72(10):e533-e541
pubmed: 32820807
Am J Epidemiol. 2011 Jan 15;173(2):127-35
pubmed: 21081646
Clin Infect Dis. 2021 Aug 2;73(3):e652-e660
pubmed: 33373435
J Infect. 2011 May;62(5):379-87
pubmed: 21414357
Pediatrics. 2019 May;143(5):
pubmed: 30962253
Open Forum Infect Dis. 2020 Dec 22;7(12):ofaa575
pubmed: 33409334
Clin Infect Dis. 2012 Sep;55(5):687-94
pubmed: 22752512
PLoS One. 2020 Nov 2;15(11):e0241327
pubmed: 33137155
J Infect. 2020 Dec;81(6):952-960
pubmed: 32987097
Open Forum Infect Dis. 2020 Jun 06;7(7):ofaa223
pubmed: 32665959
BMJ Open Qual. 2019 Feb 13;8(1):e000351
pubmed: 30997411
Nature. 2020 Dec;588(7838):388-390
pubmed: 33324005
Pharm Pract (Granada). 2017 Apr-Jun;15(2):990
pubmed: 28690701
Lancet Infect Dis. 2021 Jun;21(6):e144
pubmed: 33275941
Intern Emerg Med. 2022 Jan;17(1):141-151
pubmed: 34185257