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Dramatic rise in antibiotic use in first year of pandemic in primary care
Antibiotics have no effect on viruses, and that includes the coronavirus. Yet in the first year of the pandemic, primary care physicians in Switzerland prescribed antibacterial medications twice as frequently as before, report researchers at the University of Basel. A risky practice, warns the research team.
18 December 2023 | Angelika Jacobs
It was a time of great uncertainty. When the first wave of the new coronavirus swept across Switzerland in winter and spring 2020, there were no diagnostic tests, no vaccines, and no effective medications. During this precarious phase, primary care physicians based in Switzerland seem to have increasingly resorted to treating patients with antibiotics, even though these medications have no effect on viruses. This was the conclusion reached by a research team led by Professor Heiner C. Bucher from the Department of Clinical Research at the University of Basel and University Hospital Basel.
As the team reports in the journal Clinical Microbiology and Infection, the use of antibiotics doubled from around eight to 16 prescriptions per 100 consultations. During the first wave of SARS-CoV-2 at the beginning of 2020, a massive rise in prescriptions of antibiotics became apparent. Prescriptions then remained at an above-average level throughout the year compared with previous years (2017-2019).
The researchers had already begun their study in 2017, before the pandemic, as part of the Swiss National Science Foundation’s National Research Programme (NRP) 72: Antimicrobial Resistance. The project was based on fully anonymized individual patient data taken from over two million health insurance policyholders of all age groups, as well as on billing data from doctors. The researchers investigated how the COVID-19 pandemic affected prescribing behavior, focusing on 2,945 primary care physicians and pediatricians who had already given out medium to high levels of antibiotic prescriptions in previous years.
Risk of resistance
The results indicated that the massive increase in prescribing held true across all classes of antibiotics, even those that were not primarily intended for the treatment of respiratory infections. “This is particularly worrying because the over- and misuse of antibiotics increases the risk of bacteria becoming resistant to the drug used,” says Heiner C. Bucher. Multi-resistant bacteria lead to infections that are very hard to treat.
According to the researchers’ analysis, the rise in antibiotic prescriptions was not caused by “blind prescribing”, such as via telephone consultations. The majority of the prescriptions were made out during consultations in the doctor’s office. It also transpired that doctors carried out more blood tests for the detection of inflammation in their practices. The most likely explanation for the massive upsurge in prescriptions seemed to be that physicians were concerned about the possibility of a COVID-19 infection also leading to bacterial complications. The lack of diagnostic and treatment options for COVID-19 also played a role, researchers suspect.
Vulnerable patients
During the first year of the pandemic, the doctors in the study found themselves primarily confronted with particularly vulnerable groups of patients: while the total number of consultations halved in the first year of the pandemic compared with the previous years, the number of consultations with patients suffering from sometimes severe pre-existing conditions doubled.
“When preparing for future pandemics, we must limit the expected massive use of antibiotics through suitable measures, such as targeted information strategies, in order to reduce unnecessary prescriptions and therefore the risk of resistance,” emphasizes Heiner C. Bucher.
The research team now intends to investigate whether prescribing practices have changed again in the years following the pandemic. In collaboration with the Swiss Centre for Antibiotic Resistance (ANRESIS), they also aim to discover how resistance develops as a consequence of increased antibiotic usage.
Original publication
Soheila Aghlmandi, Florian S. Halbeisen, Pascal Godet, Andri Signorell, Simon Sigrist, Ramon Saccilotto, Andreas F. Widmer, Andreas Zeller, Julia Bielicki, Heiner C. Bucher
Impact of the COVID-19 pandemic on antibiotic prescribing in high-prescribing primary care physicians in Switzerland
Clinical Microbiology and Infection (2023), doi: 10.1016/j.cmi.2023.11.010
Further information
Prof. Dr. med. Heiner C. Bucher Emeritus, University of Basel/University Hospital of Basel, Department of Clinical Research, email: heiner.bucher@usb.ch, phone +41 79 542 98 60
Dr. Soheila Aghlmandi, University Children's Hospital of Basel (UKBB), email: Soheila.aghlmandi@ukbb.ch, phone +41 76 242 44 41
