Antibiotic use plunged during pandemic

The use of antibiotics fell sharply during the COVID-19 pandemic, according to a new study in France. The research suggests that antimicrobial prescriptions declined during periods of social distancing, including for conditions such as urinary tract infections. French scientists suggest the findings show that antibiotics were overused for some conditions before pandemic.

Inappropriate use of antibiotics is strongly linked to antimicrobial resistance (AMR) in which bacterial illnesses become harder to treat because pathogens are not responsive to existing medicines. Experts have warned that, in an extreme scenario, some bacterial infection would become untreatable. This could tip the risk-benefit balance for routine surgical procedures given the danger associated with hard-to-treat infection.

Healthcare-acquired infections are already a major problem in most care settings, especially hospitals and care homes. In 2020, more than 865,000 resistant infections occurred across the EU and more than 35,000 people lost their lives due to resistant infections every year.

Globally, AMR is estimated to cause 1.2 million direct deaths annually. A further 4.95 million deaths were associated with AMR in 2019. By 2050, forecasts predict 1.91 million deaths directly attributable to AMR and 8.22 million deaths associated with it.

The new study looked at changes in ambulatory use of antibiotics in France between 2020 and 2022. The goal was to assess how disruption to health care access and prescribing patterns would affect antibiotic use.

Researchers used nationwide health insurance data covering 67 million people to track monthly antibiotic prescriptions from January 2010 to March 2022. They applied interrupted time-series analysis to measure changes in antibiotic use following the first national lockdown on March 17, 2020.

The use of most antibiotics significantly decreased after the first lockdown and remained lower for at least 12 months compared with expected levels. Prescriptions of amoxicillin fell by 27.5% after three months, and by 55.5% at 12 months. Use of amoxicillin-clavulanic acid was down 10.9% at 3 months and 24.9% at 12 months. For Cefepime, the figures were down 22% at 3 months and 8.3% at 12 months.

Some antibiotics, such as colistin, phenoxymethylpenicillin and trimethoprim-sulfamethoxazole, which are associated with chronic indications temporarily increased. Azithromycin use did not decrease after the first lockdown and actually increased slightly over 12 months (+2.7%).