Aims: Public health responses to reduce SARS-CoV-2 transmission have profoundly affected the epidemiology and management of other infections. We examined the impact of COVID-19 restrictions on antibiotic dispensing in Australia. Methods: We used national claims data to investigate antibiotic dispensing trends from November 2015 to October 2020 and whether changes reflected reductions in primary care consultations. We used interrupted time series analysis to quantify changes in monthly antibiotic dispensing and face-to-face and telehealth GP consultations and examined changes by recipient age, pharmacy State and prescriber specialty. Results: Over the study period, an estimated 19 921 370 people had 125 495 137 antibiotic dispensings, 71% prescribed by GPs. Following COVID-19 restrictions, we observed a sustained 36% (95% CI: 33–40%) reduction in antibiotic dispensings from April 2020. Antibiotics recommended for managing respiratory tract infections showed large reductions (range 51–69%), whereas those recommended for non-respiratory infections were unchanged. Dispensings prescribed by GPs decreased from 63.5 per 1000 population for April–October 2019 to 37.0 per 1000 for April–October 2020. Total GP consultation rates remained stable, but from April 2020, 31% of consultations were telehealth. Conclusion: In a setting with a low COVID-19 incidence, restrictions were associated with a substantial reduction in community dispensings of antibiotics primarily used to treat respiratory infections, coincident with reported reductions in respiratory viral infections. Our findings are informative for post-pandemic antimicrobial stewardship and highlight the potential to reduce inappropriate prescribing by GPs and specialists for respiratory viral infections.
We thank the Australian Government Services Australia for providing the data and Melisa Litchfield for assisting with data access and ethics approval. This work was supported by the National Health and Medical Research Council (NHMRC) Centre of Research Excellence in Medicines Intelligence [grant number 1196900]. Dr Zoega is supported by a UNSW Scientia Fellowship. Dr Schaffer is supported by an NHMRC Early Career Fellowship [grant number 1158763]. Dr Burgner is supported by an NHMRC Investigator Grant [grant number 1175744]. Dr Nassar was supported by the Financial Markets Foundation for Children and NHMRC Investigator Grant [grant number APP1197940]. Research at the Murdoch Children's Research Institute is supported by the Victorian Government's Operational Infrastructure Program. The WHO Collaborating Centre for Reference and Research on Influenza is supported by the Australian Government Department of Health. The funding bodies did not play any role in the study.
© 2021 The Authors. British Journal of Clinical Pharmacology published by John Wiley & Sons Ltd on behalf of British Pharmacological Society.