COVID-19 and Outpatient Antibiotic Prescriptions in the United States: A County-Level Analysis

作者：Alisa Hamilton, Suprena Poleon, Jerald Cherian, Sara E. Cosgrove, Ramanan Laxminarayan, Eili Klein · 发表于：Open Forum Infectious Diseases · 年份：2023 · DOI：10.1093/ofid/ofad096 · 被引用次数：24 · 研究领域：Antibiotic Use and Resistance、COVID-19 epidemiological studies、Pneumonia and Respiratory Infections

Abstract Background 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. Methods 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. Results 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%; P < .01) increase in prescriptions per 100 000 population dispensed to all ages and a 0.012% (95% CI, −0.017% to −0.008%; P < .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%; P < .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. Conclusions 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 COV...