Antibiotic prescriptions decreased substantially after the first months of the COVID-19 pandemic, according to data from Veterans Affairs (VA) hospitals. The report was published Wednesday in Infection Control & Hospital Epidemiology.
Previous research has shown that 65% to 80% of COVID-19 patients across the globe had received antibiotics in the early months of the pandemic. This was because other treatments were lacking, there were concerns about the addition of bacterial infections, and some early reports claimed azithromycin might offer benefits to people with the virus. But once experts found that the drug didn’t help, antibiotic use for COVID-19 dropped.
In the current report, investigators analyzed data on antibiotic use, patient days and COVID-19 care at 108 VA facilities from January 2016 through October 2022.
The average system-wide rates of antibiotic use went up from 534 days of therapy (DOT) per 1,000 patient days present (DP) before the pandemic to to 588 DOT/DP in March and April 2020. During those months, antibiotic use was 30% higher in COVID-19 patients than in people without the virus, the data showed.
The higher rate of antibiotic use in those early months was driven by treatment for community acquired pneumonia. After April 2020, rates of antibiotic use went down in those with and without COVID-19. It was only 4% higher for the rest of 2020.
In fact, total antibiotic use in 2020 was 2% lower than in 2019 — a trend that continued through 2022. In 2022, system-wide antibiotic use was 9% less in people with COVID-19. Still, antibiotic use remained higher in COVID-19 patients at 25% of VA facilities, the authors pointed out.
“In summary, the rapid normalization of antibiotic use in persons with COVID-19 over the course of the pandemic and the continued downward trend in antibiotic use throughout the VA is reassuring, especially since many antimicrobial stewards’ usual activities were co-opted by pandemic-related tasks,” the study authors wrote. “However, substantial variations in antimicrobial use persisted across institutions.”
