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Source / Disclosures
Disclosures: Lepak reports receiving grants from Amplyx, Cidara, Fedora, KBP Biosciences, Matinas, Melinta, Merck, MicuRx, Nosopharm, Paratek and Wockhardt outside of the study. Please see the study for relevant financial information from all other authors.
A “marked decrease” in respiratory virus detections correlated with a 79% reduction in ambulatory antibiotic prescribing rates for respiratory tract infections during the COVID-19 pandemic, researchers from a pre-study study wrote. post.
The trend was seen at the University of Wisconsin (UW) Health, an academic health system with more than 80 outpatient sites and 7,000,000 outpatient visits each year, according to the researchers.
“We saw dramatic scenes statewide decrease in respiratory viruses through the usual respiratory viral season ”, Alexander J. Lepak, MD, a professor of infectious diseases in the School of Medicine and Public Health at the University of Wisconsin, told Healio Primary Care.
A similar trend has been observed in other geographic regions, he added.
“As respiratory viruses are unfortunately one of the most common reasons for antibiotic prescriptions in outpatient care, we hypothesized that the dramatic decline in respiratory viruses is associated with a decrease in outpatient antibiotic prescriptions.” , Lepak said. “We felt this was an interesting opportunity to quantify the impact of respiratory viruses on outpatient antibiotic prescribing.”
Lepak and colleagues searched Wisconsin polymerase chain reaction surveillance data for influenza, respiratory syncytial virus, human parainfluenza virus, human metapneumovirus, seasonal coronavirus, adenovirus, and enterovirus / rhinovirus. . They also used an electronic health record tool to analyze changes in respiratory virus detections, antibiotic prescriptions for 1,000 patient visits, and antibiotic prescriptions for respiratory tract infections for 1,000 patient visits. patients. Data was collected from a pre-pandemic period (July 2018 to February 2020), a one month break-in period (March 2020) and a COVID-19 pandemic period (April 2020 to February).
The researchers reported in JAMA Internal Medicine that the number of outpatient visits was similar during the pre-pandemic and post-pandemic period (637,000 versus 661,000 per month; P = 0.24). However, monthly visits related to influenza, RSV and seasonal coronaviruses declined during the pandemic compared to previous seasons (12 versus 4,800; P <.001). Other monthly respiratory virus detections also fell (560 versus 228; P <.001).
Although antibiotic prescribing increased during the winter respiratory viral seasons during the pre-pandemic period, short-term antibiotic prescription rates fell during the pandemic and remained low throughout the pandemic period. according to the researchers. After adjusting for this seasonality, monthly antibiotic prescriptions for respiratory tract infections decreased for every 1,000 patient visits (79%; 10.5 prescriptions versus 2.2 prescriptions; P <.001). The non-influenza virus showed the strongest relationship with the prescription of antibiotics for respiratory tract infections (r = 0.82; P <.001).
“This has translated into our healthcare system of about 10 fewer prescriptions for antibiotics for respiratory tract infections per 1,000 encounters, which translates to almost 80,000 fewer prescriptions during the pandemic period. of 12-month COVID-19 in our study, “Lepak said in the interview.
“We expected a drop, but I have to admit, I didn’t expect such a dramatic drop,” he continued. “This number still gives me a break and was surprising how much of an impact it has made.”
According to Lepak, strategies to limit the spread of COVID-19 have likely had a “dramatic effect” in reducing respiratory virus activity and provided a “huge opportunity” to drastically reduce antibiotic prescribing rates for respiratory viruses.
He added that the results underscore the need for “more comprehensive, accessible and timely viral respiratory tests” in ambulatory care settings.
“When providers and patients know what they have and can confirm that it is a respiratory virus, the provider and patient are much more likely to be more comfortable with symptomatic treatment only. and avoid prescriptions for antibiotics, ”he said.
Perspective
Hana Akselrod, MD, MPH
Although this interesting article by Lepak and colleagues presents the usual limitations of studies based on the EHR, its results seem representative of the patterns that have been observed in clinical practice and epidemiological studies in the last year.
The Lepak study also goes one step further and examines patterns of antibiotic prescribing within the same healthcare system, finding a significant decrease in prescriptions for respiratory tract disease but not for other causes. This new finding also makes sense in terms of what we see in clinical practice. Although the study design does not include individual patient outcomes (for example, if a patient who was not initially prescribed antibiotics for a respiratory tract infection later needs them), the conclusion Overall a 79% decrease in antibiotic prescriptions for respiratory tract infections in outpatient patients is quite impressive.
This study highlights two long-standing public health issues: # 1, the seasonal burden of respiratory tract infections, and # 2, the issue of overprescribing antibiotics for non-bacterial infections in the background. of the COVID-19 pandemic. Masking and other non-pharmacological interventions for respiratory tract infections are very effective when used consistently. The experience of the past year should encourage us to keep these tools available and socially acceptable during “cold and flu season” to reduce the annual burden of illness, lost work and school days at home. young people and mortality in the elderly and medically. vulnerable.
Before the COVID-19 pandemic, the CDC and WHO viewed antimicrobial resistance as one of the greatest public health challenges of our time, and there were concerns that some of the trends were worsening. the cause of antimicrobial resistance, including the frequent use of broad-spectrum antibiotics in patients with severe COVID-19 and decreased consistency of non-COVID isolation precautions due to constraints on supplies of personal protective equipment.
More studies are needed on how the pandemic has affected antimicrobial resistance, effective measures to mitigate it, and how it differs in hospitals versus outpatient settings. It would also be important to explore the relative role of prescriber behavior (eg, tendency to prescribe antibiotics) versus patient preferences and care-seeking behavior (eg, threshold to see a doctor) and how practice closures and telemedicine might have contributed to these. It would also be interesting to see if there are differences in respiratory tract infections and antibiotic prescribing patterns between states based on the pandemic restrictions implemented and when.
The references:
CDC. Antibiotic / antimicrobial resistance. Available at: https://www.cdc.gov/drugresistance/index.html. Accessed June 21, 2021.
Olsen SJ, et al. MMWR Morbid Mortal Weekly Representative. 2020; doi: 10.15585.mmwr.mm6937a6.
Look K. American scientist. The flu has disappeared around the world during the COVID-19 pandemic. Available at: https://www.scientificamerican.com/article/flu-has-disappeared-worldwide-during-the-covid-pandemic1. Accessed June 21, 2021.
Rodriguez-Baño J, et al. Trans R Soc Trop Med Hyg. 2021; doi: 10.1093 / trstmh / trab048.
Hana Akselrod, MD, MPH
Assistant Professor and Physician, Division of Infectious Diseases
George Washington University School of Medicine and Health Sciences
Disclosures: Akselrod does not report any relevant financial disclosure.
COVID-19 Resource Center
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