Community Antibiotic Use at the Population Level During the SARS-CoV-2 Pandemic in British Columbia, Canada

Abdullah A Mamun; Ariana Saatchi; Max Xie; Hannah Lishman; Edith Blondel-Hill; Fawziah Marra; David M Patrick

doi:10.1093/ofid/ofab185

Community Antibiotic Use at the Population Level During the SARS-CoV-2 Pandemic in British Columbia, Canada

Open Forum Infect Dis. 2021 Apr 13;8(6):ofab185. doi: 10.1093/ofid/ofab185. eCollection 2021 Jun.

Authors

Abdullah A Mamun¹, Ariana Saatchi², Max Xie¹, Hannah Lishman³, Edith Blondel-Hill⁴, Fawziah Marra², David M Patrick^{1

3}

Affiliations

¹ British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.
² Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada.
³ School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
⁴ Interior Health Authority, Kelowna, British Columbia, Canada.

Abstract

Background: The objective of this study was to examine the aggregate rates of antibiotic use at the population level and compare these rates over time against historical averages to identify the effect of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the resulting control measures on community prescribing.

Methods: We collected antibiotic prescriptions and physician office visits from January 1, 2016, to July 21, 2020. We calculated monthly prescription rates stratified by sex, age group, profession, diagnosis type, and antibiotic class. We looked at monthly prescription rate as a moving average over time. Using the interrupted time series analysis method, we estimated the changes in prescription rates after March 2020.

Results: The moving average of overall monthly prescription rates during January-June 2020 was below the minimum of the historical years' moving averages (2016-2019). We observed a >30% reduction in overall monthly prescription rates in April, May, and July of 2020 compared with the same months of 2019. We observed that overall monthly prescription rates experienced a significant level change of -12.79 (P < .001) during the coronavirus disease 2019 pandemic after March 2020, with the greatest level change being -18.02 among children 1-4 years of age (P < .001). We estimated an average -5.94 (P < .001) change in respiratory tract infection (RTI)-associated monthly prescription rates after March 2020. Overall prescription rates comparing January-July 2019 and their 2020 counterparts showed a decrease in monthly prescribing ranging from -1 to -5 for amoxicillin, amoxicillin and enzyme inhibitors, azithromycin, clarithromycin, and sulfamethoxazole.

Conclusions: In British Columbia, Canada, overall and RTI-specific monthly antibiotic prescription rates declined significantly during April-July 2020 compared with the same months in prepandemic years.

Keywords: COVID-19; Canada; SARS-CoV-2; antibiotics; pandemic.