Study estimates the associations of global and regional antibiotic use with COVID-19 cases and vaccinations during 2020–2022

By Pooja Toshniwal PahariaReviewed by Danielle Ellis, B.Sc.Feb 9 2023

In a recent study published in The Lancet’s eClinical Medicine, researchers evaluated the association between coronavirus disease 2019 (COVID-19) cases and vaccinations with antibiotic use worldwide during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic between 2020 and 2022.

Background

Antimicrobial resistance (AMR) is an established threat to global health, with considerable AMR-associated mortality reported worldwide. Antibiotic usage, especially inappropriate or over-usage for infections such as the common cold and flu contributes largely to AMR. Moreover, antibiotic prescription rates to SARS-CoV-2-positive individuals far exceed that of bacterial coinfections in the patients, probably exacerbating AMR.

Clinical analyses of managing SARS-CoV-2 infections have reported increased antibiotic usage; however, the impact of the COVID-19 pandemic on antibiotic use across the globe, including for cases other than COVID-19, has not been completely characterized. Improving understanding of COVID-19’s impact on global antibiotic usage could aid in formulating antimicrobial stewardship policies for COVID-19 patients.

About the study

In the present study, researchers reported on global antibiotic usage in the coronavirus disease 2019 scenario between 2020 and 2022.

Month-wise data on sale volumes of broad-spectrum antibiotics (penicillins, cephalosporins, tetracyclines, and macrolides) were retrieved from the IQVIA MIDAS® database for 71 nations for the pandemic period between March 2020 and May 2022. The information was integrated with national-level and month-wise data on SARS-CoV-2 infections and vaccinations, retrieved from the Our World in Data (OWD) database. Worldwide patterns of antibiotic consumption were examined for the pre-pandemic period between January 2018 and May 2022.

Fixed-effects regression modeling and pooled (least squares) regression modeling were performed to evaluate the relationship between global antibiotic usage and SARS-CoV-2 infections vaccinations for every 1,000 individuals. Using OWD data, month-wise antibiotic consumption was transformed into volume data from the IQVIA MIDAS database to month-wise antibiotic use by every 1,000 individuals. SARS-CoV-2 infection indicators were assessed, such as the documented daily COVID-19 incidence and daily vaccination counts.

Data on SARS-CoV-2 infections from March 2020 to May 2022 and SARS-CoV-2 vaccinations from December 2020 to May 2022 were analyzed. Anonymous data aggregated at the national level were analyzed. The OWD database provided nation-wise SARS-CoV-2 infection statistics retrieved from the Johns Hopkins University coronavirus disease 2019 database. OWD yielded data on SARS-CoV-2 infection-associated hospital admissions, intensive care unit (ICU) admissions, and vaccinations.

In addition, data on economic variables, demographic variables, health service accessibility, and indicators of COVID-19 outcomes, including population, the median value for age, per capita gross domestic product, per capita hospital bed availability, and smoking habits in every nation, were obtained from local and international agencies, including the United Nations and World Bank.

Results and discussion

The consumption of all broad-spectrum antibiotics investigated declined sharply from April to May of 2020, and a gradual subsequent elevation to almost pre-COVID-19 levels by May 2022. Fixed-effects-type regression modeling considering SARS-CoV-2 vaccinations showed a 10.0% elevation in month-wise COVID-19 case counts, in association with 0.60%, 0.20%, 0.20%, and 0.30% greater use of macrolides, penicillins, cephalosporins, and all antibiotics (combined), among every 1,000 individuals, respectively. Concerning penicillin antibiotics, a 10.0% rise in month-wise SARS-CoV-2 vaccinations was related to 0.10% more sales among every 1,000 individuals.

Pooled-type regression modeling, considering SARS-CoV-2 vaccinations, showed a 10.0% elevation in month-wise COVID-19 case counts in association with 0.80% greater macrolide use and a 10.0% elevation in SARS-CoV-2 vaccinations per month related to 0.20% lesser macrolide use among every 1,000 individuals. Continent-wise fixed-effects-type regression modeling showed the most statistically significant relationships for macrolide antibiotics, with 0.80%, 0.40%, 1.50%, and 1.30%, and elevations in antibiotic use for a 10.0% rise in SARS-CoV-2 infections in Europe, Asia, Africa, and North America, respectively, considering COVID-19 vaccinations.

Among all continents, significant relationships between antibiotic consumption and SARS-CoV-2 infections were observed mainly in Europe, and among antibiotic medications investigated, the associations were significant mainly for macrolide antibiotics. The relationship between antibiotic consumption and SARS-CoV-2 vaccinations was not consistent, and the findings obtained from fixed-effects-type and pooled-type regression modeling analyses were similar.

The decrease in antibiotic use in the initial COVID-19 months was bigger than seasonal decreases observed in prior years. It could be attributed to the implementation of non-pharmaceutical interventions for COVID-19 mitigation, including closures, lockdowns, and limitations on social interactions and travel.

COVID-19 patients consumed antibiotics in considerable amounts; however, socioeconomic factors and non-SARS-CoV-2 infections could affect global antibiotic sales. The economic impact of COVID-19 could have reduced antibiotic use and accessibility. Greater incidence of respiratory syncytial virus (RSV) infections and other infections could have driven the association between SARS-CoV-2 vaccinations and penicillin use in the fixed-effects-type regression modeling.

Conclusion

Based on the study findings, the impact of the COVID-19 pandemic on enhancing broad-spectrum antibiotic usage is modest, probably due to lesser non-SARS-CoV-2 infections. Nevertheless, the inappropriate or over usage of antibiotics during the COVID-19 pandemic must be prevented.