Zhu Nina, Aylin Paul, Rawson Timothy, Gilchrist Mark, Majeed Azeem, Holmes Alison
National Institute for Health Research, Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK.
National Institute for Health Research, Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK; Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK.
Clin Microbiol Infect. 2021 Feb 16;27(5):762-8. doi: 10.1016/j.cmi.2021.02.007.
We investigated the impact of COVID-19 and national pandemic response on primary care antibiotic prescribing in London.
Individual prescribing records between 2015 and 2020 for 2 million residents in north west London were analysed. Prescribing records were linked to SARS-CoV-2 test results. Prescribing volumes, in total, and stratified by patient characteristics, antibiotic class and AWaRe classification, were investigated. Interrupted time series analysis was performed to detect measurable change in the trend of prescribing volume since the national lockdown in March 2020, immediately before the first COVID-19 peak in London.
Records covering 366 059 patients, 730 001 antibiotic items and 848 201 SARS-CoV-2 tests between January and November 2020 were analysed. Before March 2020, there was a background downward trend (decreasing by 584 items/month) in primary care antibiotic prescribing. This reduction rate accelerated to 3504 items/month from March 2020. This rate of decrease was sustained beyond the initial peak, continuing into winter and the second peak. Despite an overall reduction in prescribing volume, co-amoxiclav, a broad-spectrum "Access" antibiotic, prescribing rose by 70.1% in patients aged 50 and older from February to April. Commonly prescribed antibiotics within 14 days of a positive SARS-CoV-2 test were amoxicillin (863/2474, 34.9%) and doxycycline (678/2474, 27.4%). This aligned with national guidelines on management of community pneumonia of unclear cause. The proportion of "Watch" antibiotics used decreased during the peak in COVID-19.
A sustained reduction in community antibiotic prescribing has been observed since the first lockdown. Investigation of community-onset infectious diseases and potential unintended consequences of reduced prescribing is urgently needed.
我们研究了新冠疫情及国家疫情应对措施对伦敦初级医疗保健机构抗生素处方开具的影响。
分析了2015年至2020年间伦敦西北部200万居民的个人处方记录。处方记录与新冠病毒检测结果相关联。研究了总体处方量，并按患者特征、抗生素类别和AWaRe分类进行分层。进行了中断时间序列分析，以检测自2020年3月全国封锁以来（恰好在伦敦首个新冠疫情高峰之前）处方量趋势的可测量变化。
分析了2020年1月至11月期间涵盖366059名患者、730001项抗生素项目和848201次新冠病毒检测的记录。2020年3月之前，初级医疗保健机构抗生素处方开具呈背景性下降趋势（每月减少584项）。从2020年3月起，这一减少率加速至每月3504项。这种下降速度在最初的高峰之后仍持续，一直持续到冬季和第二个高峰。尽管处方量总体减少，但广谱“可及”抗生素阿莫西林克拉维酸钾在50岁及以上患者中的处方量从2月到4月上升了70.1%。新冠病毒检测呈阳性后的14天内，常用的抗生素是阿莫西林（863/2474，34.9%）和多西环素（678/2474，27.4%）。这与不明原因社区肺炎管理的国家指南一致。在新冠疫情高峰期间，“慎用”抗生素的使用比例下降。
自首次封锁以来，社区抗生素处方开具持续减少。迫切需要对社区发病的传染病以及处方减少的潜在意外后果进行调查。
