2019冠状病毒病大流行期间的全球抗生素使用情况：对2020年至2022年71个国家药品销售数据的分析

Global antibiotic use during the COVID-19 pandemic: analysis of pharmaceutical sales data from 71 countries, 2020-2022.

作者信息

Nandi Arindam, Pecetta Simone, Bloom David E

机构信息

The Population Council, New York, USA.

One Health Trust, Washington DC, USA.

出版信息

EClinicalMedicine. 2023 Mar;57:101848. doi: 10.1016/j.eclinm.2023.101848. Epub 2023 Feb 6.

DOI:10.1016/j.eclinm.2023.101848

PMID:36776504

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9900305/

Abstract

BACKGROUND

Despite bacterial coinfection rates of less than 10%, antibiotics are prescribed to an estimated 75% of patients with COVID-19, potentially exacerbating antimicrobial resistance. We estimated the associations of COVID-19 cases and vaccinations with global antibiotic sales during the first two years of the COVID-19 pandemic.

METHODS

We obtained monthly data on broad-spectrum antibiotic sales volumes (cephalosporins, penicillins, macrolides, and tetracyclines) in 71 countries during March 2020-May 2022 from the IQVIA MIDAS® database. These data were combined with country-month-level COVID-19 case and vaccination data from Our World in Data. We used least squares (pooled) and fixed-effects panel data regression models, accounting for country characteristics, to estimate the associations between antibiotic sales volumes and COVID-19 cases and vaccinations per 1000 people.

FINDINGS

Sales of all four antibiotics fell sharply during April and May 2020, followed by a gradual rise to near pre-pandemic levels through May 2022. In fixed-effects regression models, a 10% increase in monthly COVID-19 cases was associated with 0.2%-0.3% higher sales of cephalosporins, 0.2%-0.3% higher sales of penicillins, 0.4%-0.6% higher sales of macrolides, and 0.3% higher sales of all four antibiotics combined per 1000 people. Across continents, a 10% increase in monthly COVID-19 cases was associated with 0.8%, 1.3%, and 1.5% higher macrolides sales in Europe, North America, and Africa respectively. Sales of other antibiotics across continent were also positively associated with COVID-19 cases, although the estimated associations were smaller in magnitude. No consistent associations were observed between antibiotic sales and COVID-19 vaccinations. Results from pooled regression analysis were similar to those from the fixed-effects models.

INTERPRETATION

Antibiotic sales were positively associated with COVID-19 cases globally during 2020-2022. Our findings underline that antibiotic stewardship in the context of COVID-19 remains essential.

FUNDING

Bill & Melinda Gates Foundation.

摘要

背景

尽管细菌合并感染率低于10%，但估计有75%的新冠肺炎患者使用了抗生素，这可能会加剧抗菌药物耐药性。我们估计了在新冠肺炎疫情的头两年，新冠肺炎病例和疫苗接种与全球抗生素销售额之间的关联。

方法

我们从艾昆纬MIDAS®数据库中获取了2020年3月至2022年5月期间71个国家的广谱抗生素（头孢菌素、青霉素、大环内酯类和四环素类）月销售量数据。这些数据与来自“Our World in Data”的国家月度新冠肺炎病例和疫苗接种数据相结合。我们使用最小二乘法（汇总）和固定效应面板数据回归模型，并考虑国家特征，来估计每1000人抗生素销售量与新冠肺炎病例和疫苗接种之间的关联。

结果

2020年4月和5月，所有四种抗生素的销售额均大幅下降，随后逐渐上升，到2022年5月接近疫情前水平。在固定效应回归模型中，每月新冠肺炎病例增加10%，每1000人中头孢菌素销售额增加0.2%-0.3%，青霉素销售额增加0.2%-0.3%，大环内酯类销售额增加0.4%-0.6%，所有四种抗生素的总销售额增加0.3%。在各大洲中，每月新冠肺炎病例增加10%，欧洲、北美和非洲的大环内酯类销售额分别增加0.8%、1.3%和1.5%。其他抗生素在各大洲的销售额也与新冠肺炎病例呈正相关，尽管估计的关联程度较小。未观察到抗生素销售额与新冠肺炎疫苗接种之间存在一致的关联。汇总回归分析的结果与固定效应模型相似。