Hamilton Alisa, Poleon Suprena, Cherian Jerald, Cosgrove Sara, Laxminarayan Ramanan, Klein Eili
One Health Trust, Washington, DC, USA.
Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Open Forum Infect Dis. 2023 Feb 22;10(3):ofad096. doi: 10.1093/ofid/ofad096. eCollection 2023 Mar.
Declines in outpatient antibiotic prescribing were reported during the beginning of the coronavirus disease 2019 (COVID-19) pandemic in the United States; however, the overall impact of COVID-19 cases on antibiotic prescribing remains unclear.
This was an ecological study using random-effects panel regression of monthly reported COVID-19 county case and antibiotic prescription data, controlling for seasonality, urbanicity, health care access, nonpharmaceutical interventions (NPIs), and sociodemographic factors.
Antibiotic prescribing fell 26.8% in 2020 compared with prior years. Each 1% increase in county-level monthly COVID-19 cases was associated with a 0.009% (95% CI, 0.007% to 0.012%; < .01) increase in prescriptions per 100 000 population dispensed to all ages and a 0.012% (95% CI, -0.017% to -0.008%; < .01) decrease in prescriptions per 100 000 children. Counties with schools open for in-person instruction were associated with a 0.044% (95% CI, 0.024% to 0.065%; < .01) increase in prescriptions per 100 000 children compared with counties that closed schools. Internal movement restrictions and requiring facemasks were also associated with lower prescribing among children.
The positive association of COVID-19 cases with prescribing for all ages and the negative association for children indicate that increases in prescribing occurred primarily among adults. The rarity of bacterial coinfection in COVID-19 patients suggests that a fraction of these prescriptions may have been inappropriate. Facemasks and school closures were correlated with reductions in prescribing among children, possibly due to the prevention of other upper respiratory infections. The strongest predictors of prescribing were prior years' prescribing trends, suggesting the possibility that behavioral norms are an important driver of prescribing practices.
在美国2019冠状病毒病（COVID-19）大流行初期，门诊抗生素处方量有所下降；然而，COVID-19病例对抗生素处方的总体影响仍不明确。
这是一项生态学研究，采用随机效应面板回归分析每月报告的县级COVID-19病例和抗生素处方数据，并对季节性、城市化程度、医疗保健可及性、非药物干预措施（NPIs）和社会人口学因素进行控制。
与前几年相比，2020年抗生素处方量下降了26.8%。县级每月COVID-19病例每增加1%，每10万人口中所有年龄段的处方量增加0.009%（95%CI，0.007%至0.012%；P<0.01），每10万儿童的处方量减少0.012%（95%CI，-0.017%至-0.008%；P<0.01）。与关闭学校的县相比，学校开放进行面授教学的县每10万儿童的处方量增加0.044%（95%CI，0.024%至0.065%；P<0.01）。内部流动限制和要求佩戴口罩也与儿童处方量较低有关。
COVID-19病例与所有年龄段处方量呈正相关，与儿童处方量呈负相关，这表明处方量增加主要发生在成年人中。COVID-19患者细菌合并感染的罕见性表明，这些处方中有一部分可能是不适当的。口罩佩戴和学校关闭与儿童处方量减少相关，可能是由于预防了其他上呼吸道感染。处方量的最强预测因素是前几年的处方趋势，这表明行为规范可能是处方行为的重要驱动因素。
