Study looks at antibiotic use during COVID-19 by age

In a survey published in JAMA Health Foruminvestigators determined antibiotic prescribing during outpatient visits related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection by United States (US) residents age 64 and younger with commercial health insurance. was evaluated.

The 2019 coronavirus disease (COVID-19) pandemic is causing unprecedented morbidity and mortality worldwide. A significant proportion of outpatient visits related to a Medicare policyholder’s SARS-CoV-2 infection have resulted in prescriptions for antibiotics. Analysis of COVID-19-related antibiotic prescribing could potentially inform antibiotic management policies and programs.

Research letter: Outpatient Antibiotic Receipts for COVID-19 in the United States, 2020-2022Image Credit: solarseven/Shutterstock

About research letters

In the current study letter, researchers reported the results of a study on antibiotic prescribing to COVID-19 outpatients residing in the United States between 2020 and 2022.

This cross-sectional study was conducted between 1 April 2020 and 31 May 2022 to assess trends in antibiotic prescribing to COVID-19 outpatients. The study consisted of children aged 17.0 and younger and adults aged 18 to 64 who were identified from the OptumLabs data warehouse, and their 10.0-20.0 percent anonymized US residents with health insurance. contains encrypted health insurance claims data.

Pharmacologically and medically covered individuals visiting the outpatient department were identified, and the individual’s relationship to antibiotic prescribing was assessed before or within 1 week after the visit. Analysis was limited to outpatient visits associated with SARS-CoV-2 infection and excluded 5% of individual visits with a joint diagnosis requiring antibiotics and associated antibiotic prescriptions. .

result

The study included 177,057 and 1,293,303 pediatric and adult COVID-19 outpatients, respectively. Antibiotic prescribing rates during visits related to SARS-CoV-2 infection were significantly more significant in the elderly, 4% in individuals aged 5.0 years or younger and 16.0% in individuals aged 45-64 years.

20% and 7% of physical examinations and antibiotic prescriptions for acute respiratory infections were in patients with COVID-19 of any age. In a sensitivity analysis, 4% vs. 5% of pediatric patients and 11.0% vs. 13.0% of adults prescribed antibiotics within 2 days (vs. 7 days) of the outpatient visit.

Ambulatory care for pediatric and adult patients associated with SARS-CoV-2 infection was primarily in clinics (66.0% vs. 51.0%), emergency departments (12.0% vs. 18.0%), and telemedicine Practice (11.0% vs 17.0%). Antibiotic prescription rates varied by health-care facility, with rates rising during telemedicine clinic visits and emergency department visits for all ages, except for individuals aged 5.0 years or younger.

Pediatric patients aged ≤5.0 years had the highest rates of antibiotic prescriptions in non-third-party telemedicine consultations between physicians and patients. Antibiotic prescribing rates in the Southern, Western, Midwestern, and Northeastern regions of the United States were 15.0%, 9.0%, 9.0%, and 7.0%, respectively. In children <6.0 years, azithromycin and amoxicillin were the most frequently prescribed antibiotics. Among 6- to 17-year-olds and adults, HCWs prescribed azithromycin antibiotics (68.0% and 70.0%) more frequently than amoxicillin antibiotics (15.0% and 4%).

Conclusion

Based on findings, COVID-19 outpatient antibiotic prescriptions are significantly lower in pediatric patients than in adults, with rates varying by health facility and region of the United States. Rising antibiotic prescribing rates among adults may be associated with increased prevalence of comorbidities, which may increase the risk of adverse COVID-19 outcomes.

Previous reports indicated that antibiotics were the most commonly prescribed antibiotics in emergency departments and telemedicine, and azithromycin was the most common prescription among adults and children aged 6 to 17 years. Health care professionals sometimes prescribe azithromycin, possibly because of its antiviral and anti-inflammatory properties. However, amoxicillin use among the youngest individuals raises concerns about related bacterial-type infections such as pneumonia and otitis media.

Research limitations

This study has some limitations. For example, inadequate data on Medicaid checkups and uninsured checkups, searching for data during times when pediatric checkups are less frequent than usual, and antibiotics for non-SARS-CoV-2 infections. such as the use of – Associated ARTI. Furthermore, the U07.1 code appears to be highly specific, but less sensitive in identifying health visits associated with SARS-CoV-2 infection.

Health claims data did not include antibiotics prescribed but purchased without health insurance. Furthermore, the relationship between comorbidities and the severity of COVID-19 with antibiotic use has not been evaluated. Further research into antibiotic prescribing practices during successive waves of COVID-19 could help reduce unnecessary antibiotic use and prevent the development of associated co-infections and antimicrobial resistance.