Drop in antibiotic prescribing following COVID-19 restrictions

Antibiotic prescription rates have decreased by 36 per cent following COVID-19 restrictions despite stable rates of GP consultations, according to a new study. 

The research, led by the Murdoch Children's Research Institute (MCRI) and UNSW Sydney, has examined the impact of COVID-19 restrictions on antibiotic dispensing in Australia with hopes the results will lead to targeted reductions in unwarranted prescribing in a post-pandemic era.

Australia is in the top quarter of high-income countries for antibiotic use. Inappropriate prescribing for viral upper and lower respiratory tract infections has been estimated to account for 40 per cent of antibiotics prescribed by Australian GPs.

Antibiotic prescribing contrary to clinical guidelines is a problem in both hospitals and the community in many countries and is a major driver of antimicrobial resistance.

The study, published in the British Journal of Clinical Pharmacology, showed the reduction of antibiotics prescribed by GPs were primarily used for respiratory tract infections. There were no reductions in prescribing antibiotics generally used to treat non-respiratory infections. The researchers observed the drop in antibiotic dispensing continued into winter, a contrast to the seasonality of antibiotic prescribing before the pandemic.

During the period observed by the research team (April – October 2020), similar reductions were recorded across all age groups, with no corresponding change in GP consultations over time. While people consulted GPs at the same rate as before the pandemic, a third of all consults were conducted via telehealth. This suggested the large declines in antibiotic use were unlikely due to reduced access to health care. 

"Other sources of data showed rates of respiratory infections in the community fell in this period and that is likely the reason for the decline in antibiotic use," said the lead author of the report, Dr Malcolm Gillies from UNSW.

"We believe that our findings are informative for post-pandemic antimicrobial stewardship and highlight the potential to reduce inappropriate prescribing for respiratory viral infections."

Associate Professor Helga Zoega from UNSW and a senior author of the paper said similar changes in antibiotic use happened around the world.

"However, this is the first data we know of from a country where rates of COVID-19 infection were low," she said. "The reductions observed in our study occurred during winter months (June – August) when antibiotic prescribing is normally at its highest, and they were seen across all age groups and jurisdictions despite differing levels of COVID-19 restrictions."

The researchers said there have been efforts to reduce unnecessary antibiotic use in Australia, but it is slow and difficult work.

"There is a significant body of research on what interventions are effective, and we need to keep at it," said Dr Gillies.

MCRI Professor David Burgner said: "Although most of the current focus is understandably on the pandemic, the issue of antibiotic resistance remains a public health priority both nationally and globally and one we can't afford to put on hold. A key element is ensuring we use antibiotics as judiciously as possible."

Researchers at The Royal Children's Hospital, the University of Melbourne, the University of Sydney, WHO Collaborating Centre for Reference and Research on Influenza and the University of Iceland also contributed to the findings.  

Publication: Malcolm B. Gillies, David P. Burgner, Lorraine Ivancic, Natasha Nassar, Jessica E. Miller, Sheena G. Sullivan, Isobel T. M Todd, Sallie-Anne Pearson, Andrea L. Schaffer and Helga Zoega. 'Changes in antibiotic prescribing following COVID-19 restrictions: Lessons for post-pandemic antibiotic stewardship,' British Journal of Clinical Pharmacology. DOI: 10.1111/bcp.15000

*The content of this communication is the sole responsibility of MCRI and does not reflect the views of the NHMRC.

Available for interview:

Professor David Burgner, MCRI Group Leader, Inflammatory Origins

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About MCRI

The Murdoch Children's Research Institute (MCRI) is the largest child health research institute in Australia committed to making discoveries and developing treatments to improve child and adolescent health in Australia and around the world. They are pioneering new treatments, trialling better vaccines and improving ways of diagnosing and helping sick babies, children and adolescents. It is one of the only research institutes in Australia to offer genetic testing to find answers for families of children with previously undiagnosed conditions.

Funding:

The National Health and Medical Research Council (NHMRC) Centre of Research Excellence in Medicines Intelligence (grant number 1196900). Dr Zoega is supported by a UNSW Scientia Fellowship. Dr Schaffer is supported by an NHMRC Early Career Fellowship (grant number 1158763). Dr Burgner is supported by an NHMRC Investigator Grant (grant number 1175744). Dr Nassar was supported by the Financial Markets Foundation for Children and NHMRC Investigator Grant (grant number APP1197940). Research at the Murdoch Children's Research Institute is supported by the Victorian Government's Operational Infrastructure Program. The WHO Collaborating Centre for Reference and Research on Influenza is supported by the Australian Government Department of Health.