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Antibiotics
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Antibiotics Use in Primary Care during COVID-19
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Antibiotics Use in Primary Care during COVID-19

A special issue of Antibiotics (ISSN 2079-6382). This special issue belongs to the section "Antibiotics Use and Antimicrobial Stewardship".

Deadline for manuscript submissions: closed (15 April 2022) | Viewed by 24623

Special Issue Editor

Dr. Carl Llor

E-Mail Website
Guest Editor
Research Unit for General Practice, Univeristy of South Denmark, Odense, Denmark
Interests: rational use of antibiotics; respiratory tract infections; urinary tract infections; point-of-care tests; primary health care
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Antimicrobial resistance (AMR) is a growing problem threatening societal development and human health. The pandemic caused by SARS-CoV-2 has had devastating effects on the healthcare system and the whole of society, with subsequent disruption of the normal organization of primary care. Despite the viral nature of this syndrome, studies carried out during the first wave revealed high antibiotic prescribing rates to patients with COVID-19, largely due to suspected bacterial co-infections. However, overprescribing of antibiotics in infected patients could lead to increased selective pressure caused by AMR.

The goal of this Special Issue is to gather insights into antibiotic use in primary care during the pandemic, aiming to understand the patterns and predictors of antibiotic prescribing in COVID-19 patients and to evaluate the association between reducing unnecessary antibiotic use and decreased incidence of drug-resistant infections. I welcome contributions based on both quantitative and qualitative methods, and hope to receive manuscripts from different geographical, cultural, and socioeconomic settings. I would like to invite you to submit manuscripts covering the following areas:

  • Antibiotic stewardship interventions aimed at improving the appropriateness of antibiotic use and the analysis of the gap between the prevalence of co-mixed bacterial infection in patients with COVID-19 infection and frequency of antibiotic prescribing;
  • Clinical decision-making in patients with suspected concomitant bacterial co-infections in the course of COVID-19 in primary care (e.g., use of rapid point-of-care tests, lung ultrasound, other lung imaging techniques);
  • Interprofessional collaboration in the management of COVID-19 infection, such as implementation of guidelines, severity prediction scales, quality indicators, and interventions promoting collaborative work between general practitioners and hospital physicians.

Keywords

  • Antibiotics
  • Antimicrobial stewardship
  • COVID-19
  • Primary care
  • SARS-CoV-2
  • Point-of-Care Testing

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Published Papers (6 papers)

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Editorial

Jump to: Research

3 pages, 170 KiB  
Editorial
Antibiotics Use in Primary Care during COVID-19
by Carl Llor
Antibiotics 2022, 11(6), 744; https://doi.org/10.3390/antibiotics11060744 - 31 May 2022
Cited by 3 | Viewed by 1576
Abstract
During national health emergencies such as the COVID-19 pandemic, a robust primary care system plays a crucial role in triaging, educating patients and testing [...] Full article
(This article belongs to the Special Issue Antibiotics Use in Primary Care during COVID-19)

Research

Jump to: Editorial

15 pages, 1389 KiB  
Article
Outpatient Antibiotic Prescriptions in France: Patients and Providers Characteristics and Impact of the COVID-19 Pandemic
by Wilfried BARA, Christian Brun-Buisson, Bruno Coignard and Laurence Watier
Antibiotics 2022, 11(5), 643; https://doi.org/10.3390/antibiotics11050643 - 11 May 2022
Cited by 29 | Viewed by 3437
Abstract
In France, despite several successive plans to control antimicrobial resistance, antibiotic use remains high in the outpatient setting. This study aims to better understand outpatient antibiotic use and prescription in order to identify tailored targets for future public health actions. Using data from [...] Read more.
In France, despite several successive plans to control antimicrobial resistance, antibiotic use remains high in the outpatient setting. This study aims to better understand outpatient antibiotic use and prescription in order to identify tailored targets for future public health actions. Using data from the French National Health Data System, we described and compared the individual characteristics of patients with and without an antibiotic prescription. The prescribed antibiotics (ATC-J01) were detailed and compared between 2019 and 2020. Antibiotic prescribing indicators that take prescriber activity into account were estimated and compared. Patients who were female, advanced age, and the presence of comorbidities were associated with antibiotic prescriptions. The overall prescription rate was estimated at 134 per 1000 consultations and 326 per 1000 patients seen in 2019. General practitioners (GPs), dentists and paediatricians were associated with 78.0%, 12.2% and 2.2% of antibiotic prescriptions, respectively, with high prescription rates (391, 447, and 313 p. 1000 patients seen, respectively). In comparison with 2019, this rate decreased in 2020 for paediatricians (−30.4%) and GPs (−17.9%) whereas it increased among dentists (+17.9%). The reduction was twice as high among the male prescribers than among their female counterparts (−26.6 and −12.0, respectively). The reduction in prescriptions observed in 2020 (−18.2%) was more marked in children (−35.8%) but less so among individuals ≥65 years (−13.1%) and those with comorbidities (−12.5%). The decrease in penicillin prescriptions represents 67.3% of the overall reduction observed in 2020. The heterogeneous decrease in prescriptions by age and antibiotic class could be explained by the impact of COVID-19 control measures on the spread of respiratory viruses; thus, a substantial proportion of the prescriptions avoided in 2020 is likely inappropriate, particularly among children. In order to keep the rate of prescriptions comparable to that observed in 2020, male prescribers, paediatricians and GPs should be encouraged to maintain that level, while a campaign to raise awareness of the appropriate use of antibiotics should be aimed at dentists in particular. Full article
(This article belongs to the Special Issue Antibiotics Use in Primary Care during COVID-19)
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14 pages, 1876 KiB  
Article
Antibiotic Prescription Patterns in the Paediatric Primary Care Setting before and after the COVID-19 Pandemic in Italy: An Analysis Using the AWaRe Metrics
by Elisa Barbieri, Cecilia Liberati, Anna Cantarutti, Costanza Di Chiara, Angela Lupattelli, Michael Sharland, Carlo Giaquinto, Yingfen Hsia and Daniele Doná
Antibiotics 2022, 11(4), 457; https://doi.org/10.3390/antibiotics11040457 - 29 Mar 2022
Cited by 18 | Viewed by 4113
Abstract
The containment measures following COVID-19 pandemic drastically reduced airway infections, but they also limited the access of patients to healthcare services. We aimed to assess the antibiotic prescription patterns in the Italian paediatric primary care setting before and after the containment measures implementation. [...] Read more.
The containment measures following COVID-19 pandemic drastically reduced airway infections, but they also limited the access of patients to healthcare services. We aimed to assess the antibiotic prescription patterns in the Italian paediatric primary care setting before and after the containment measures implementation. For this retrospective analysis, we used a population database, Pedianet, collecting data of patients aged 0–14 years enrolled with family paediatricians (FP) from March 2019 to March 2021. Antibiotic prescriptions were classified according to WHO AWaRe classification. An interrupted time series evaluating the impact of the containment measures implementation on the monthly antibiotic index, on the access to watch index, and on the amoxicillin to co-amoxiclav index stratified by diagnosis was performed. Overall, 121,304 antibiotic prescriptions were retrieved from 134 FP, for a total of 162,260 children. From March 2020, the antibiotic index dropped by more than 80% for respiratory infections. The Access to Watch trend did not change after the containment measures, reflecting the propensity to prescribe more broad-spectrum antibiotics for respiratory infections even during the pandemic. Similarly, co-amoxiclav was prescribed more often than amoxicillin alone for all the diagnoses, with a significant variation in the trend slope for upper respiratory tract infections prescriptions. Full article
(This article belongs to the Special Issue Antibiotics Use in Primary Care during COVID-19)
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13 pages, 276 KiB  
Article
Impact of the COVID-19 Pandemic on Community Antibiotic Prescribing and Stewardship: A Qualitative Interview Study with General Practitioners in England
by Aleksandra J. Borek, Katherine Maitland, Monsey McLeod, Anne Campbell, Benedict Hayhoe, Christopher C. Butler, Liz Morrell, Laurence S. J. Roope, Alison Holmes, Ann Sarah Walker, Sarah Tonkin-Crine and on behalf of the STEP-UP Study Team
Antibiotics 2021, 10(12), 1531; https://doi.org/10.3390/antibiotics10121531 - 14 Dec 2021
Cited by 28 | Viewed by 5087
Abstract
The COVID-19 pandemic has had a profound impact on the delivery of primary care services. We aimed to identify general practitioners’ (GPs’) perceptions and experiences of how the COVID-19 pandemic influenced antibiotic prescribing and antimicrobial stewardship (AMS) in general practice in England. Twenty-four [...] Read more.
The COVID-19 pandemic has had a profound impact on the delivery of primary care services. We aimed to identify general practitioners’ (GPs’) perceptions and experiences of how the COVID-19 pandemic influenced antibiotic prescribing and antimicrobial stewardship (AMS) in general practice in England. Twenty-four semi-structured interviews were conducted with 18 GPs at two time-points: autumn 2020 (14 interviews) and spring 2021 (10 interviews). Interviews were audio-recorded, transcribed and analysed thematically, taking a longitudinal approach. Participants reported a lower threshold for antibiotic prescribing (and fewer consultations) for respiratory infections and COVID-19 symptoms early in the pandemic, then returning to more usual (pre-pandemic) prescribing. They perceived the pandemic as having had less impact on antibiotic prescribing for urinary and skin infections. Participants perceived the changing ways of working and consulting (e.g., proportions of remote and in-person consultations) in addition to changing patient presentations and GP workloads as influencing the fluctuations in antibiotic prescribing. This was compounded by decreased engagement with, and priority of, AMS due to COVID-19-related urgent priorities. Re-engagement with AMS is needed, e.g., through reviving antibiotic prescribing feedback and targets/incentives. The pandemic disrupted, and required adaptations in, the usual ways of working and AMS. It is now important to identify opportunities, e.g., for re-organising ways of managing infections and AMS in the future. Full article
(This article belongs to the Special Issue Antibiotics Use in Primary Care during COVID-19)
12 pages, 1369 KiB  
Article
Common Infections and Antibiotic Prescribing during the First Year of the COVID-19 Pandemic: A Primary Care-Based Observational Cohort Study
by Josi A. Boeijen, Alike W. van der Velden, Saskia Hullegie, Tamara N. Platteel, Dorien L. M. Zwart, Roger A. M. J. Damoiseaux, Roderick P. Venekamp and Alma C. van de Pol
Antibiotics 2021, 10(12), 1521; https://doi.org/10.3390/antibiotics10121521 - 13 Dec 2021
Cited by 9 | Viewed by 2764
Abstract
Presentation and antibiotic prescribing for common infectious disease episodes decreased substantially during the first COVID-19 pandemic wave in Dutch general practice. We set out to determine the course of these variables during the first pandemic year. We conducted a retrospective observational cohort study [...] Read more.
Presentation and antibiotic prescribing for common infectious disease episodes decreased substantially during the first COVID-19 pandemic wave in Dutch general practice. We set out to determine the course of these variables during the first pandemic year. We conducted a retrospective observational cohort study using routine health care data from the Julius General Practitioners’ Network. All patients registered in the pre-pandemic year (n = 425,129) and/or during the first pandemic year (n = 432,122) were included. Relative risks for the number of infectious disease episodes (respiratory tract/ear, urinary tract, gastrointestinal, and skin), in total and those treated with antibiotics, and proportions of episodes treated with antibiotics (prescription rates) were calculated. Compared to the pre-pandemic year, primary care presentation for common infections remained lower during the full first pandemic year (RR, 0.77; CI, 0.76–0.78), mainly attributed to a sustained decline in respiratory tract/ear and gastrointestinal infection episodes. Presentation for urinary tract and skin infection episodes declined during the first wave, but returned to pre-pandemic levels during the second and start of the third wave. Antibiotic prescription rates were lower during the full first pandemic year (24%) as compared to the pre-pandemic year (28%), mainly attributed to a 10% lower prescription rate for respiratory tract/ear infections; the latter was not accompanied by an increase in complications. The decline in primary care presentation for common infections during the full first COVID-19 pandemic year, together with lower prescription rates for respiratory tract/ear infections, resulted in a substantial reduction in antibiotic prescribing in Dutch primary care. Full article
(This article belongs to the Special Issue Antibiotics Use in Primary Care during COVID-19)
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11 pages, 648 KiB  
Article
Correlation between Previous Antibiotic Exposure and COVID-19 Severity. A Population-Based Cohort Study
by Carl Llor, Dan Ouchi, Maria Giner-Soriano, Ana García-Sangenís, Lars Bjerrum and Rosa Morros
Antibiotics 2021, 10(11), 1364; https://doi.org/10.3390/antibiotics10111364 - 8 Nov 2021
Cited by 17 | Viewed by 6489
Abstract
We examined the correlation between previous antibiotic exposure and COVID-19 severity using a population-based observational matched cohort study with patient level data obtained for more than 5.8 million people registered in SIDIAP in Catalonia, Spain. We included all patients newly diagnosed with COVID-19 [...] Read more.
We examined the correlation between previous antibiotic exposure and COVID-19 severity using a population-based observational matched cohort study with patient level data obtained for more than 5.8 million people registered in SIDIAP in Catalonia, Spain. We included all patients newly diagnosed with COVID-19 from March to June 2020 and identified all their antibiotic prescriptions in the previous two years. We used a composite severity endpoint, including pneumonia, hospital admission and death due to COVID-19. We examined the influence of high antibiotic exposure (>4 regimens), exposure to highest priority critically important antimicrobials (HPCIA) and recent exposure. Potential confounders were adjusted by logistic regression. A total of 280,679 patients were diagnosed with COVID-19, 146,656 of whom were exposed to at least one antibiotic course (52.3%) during the preceding two years. A total of 25,222 presented severe COVID-19 infection (9%), and the risk of severity was highest among those exposed to antibiotics (OR 1.12; 95% CI: 1.04–1.21). Among all individuals exposed to antibiotics, high, recent and exposure to HPCIAs were correlated with increased COVID severity (OR 1.19; 95% CI: 1.14–1.26; 1.41; 95% CI: 1.36–1.46; and 1.35; 95% CI: 1.30–1.40, respectively). Our findings confirm a significant correlation between previous antibiotic exposure and increased severity of COVID-19 disease. Full article
(This article belongs to the Special Issue Antibiotics Use in Primary Care during COVID-19)
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