The impact of COVID-19 on consultations and antibiotic prescribing for URTI in England

By Dr. Chinta SidharthanFeb 15 2023Reviewed by Aimee Molineux

In a recent study published in the journal JAC-Antimicrobial Resistance, researchers investigated the trends in antibiotic prescriptions for upper respiratory tract infections to determine whether the decrease in in-person medical consultation appointments during the coronavirus disease 2019 (COVID-19) pandemic had an impact on the prescribing practices.

Study: Sustained increases in antibiotic prescriptions per primary care consultation for upper respiratory tract infections in England during the COVID-19 pandemic. Image Credit: i viewfinder / Shutterstock

Background

Antimicrobial resistance is a growing concern on various levels. Apart from the danger of microbial infections that are extremely difficult to treat, the disproportionate costs and benefits of developing new antimicrobials have resulted in a decrease in the number of new antibiotics being developed. To reduce the threat of antimicrobial resistance, the United Kingdom (U.K.) government published an action plan in 2019, which includes metrics for the reduction of inappropriate primary care antibiotic prescriptions.

Studies have found that in the U.K., the highest number of inappropriate antibiotic prescriptions were for upper respiratory tract infections, and 72.7% of all antibiotic prescriptions were from general practitioners. Given that upper respiratory tract infections are caused by viruses and are generally self-limiting, antibiotic prescriptions to treat such infections are considered inappropriate. Furthermore, the significant decrease in face-to-face healthcare appointments and increase in telephonic consultations during the COVID-19 pandemic could have impacted the prescribing practices among general practitioners.

About the study

In the present study, the researchers used deidentified electronic medical records comprising age, gender, symptoms and diagnoses, prescription information such as drug code, date of consultation and prescription issue, and geographic location to conduct an interrupted time-series analysis. The patient data also contained information on whether the consultation was telephonic or in-person.

Symptom and diagnosis codes were used to determine the upper respiratory tract infection cases, and antibiotic prescriptions on the same day as the consultation for the upper respiratory tract infection were identified. The study excluded patients prescribed anti-leprotic or anti-tuberculosis medications the same day as the upper respiratory tract infection consultation.

The consultation rates for upper respiratory tract infections were calculated for the total number of registered patients, and the antibiotic prescription rates were calculated for the total number of upper respiratory tract infection consultations. The changes in antibiotic prescription trends were calculated through an interrupted time-series analysis of the entire patient population and for subgroups based on geographic location, age, and gender.

Results

The results reported that after implementing COVID-19-related lockdown measures in the U.K. around March 2020, antibiotic prescriptions increased by 105.7 items per 1000 upper respiratory tract infection consultations. Moreover, this increase in antibiotic prescription rates was sustained till May 2022. In total, 518,859 patients had consulted at least once for an upper respiratory tract infection during the study period, and 50.7% (262,851) of the patients were prescribed an antibiotic at least once. In total, there were 1,079,545 upper respiratory tract infection consultations and 442,387 antibiotic prescriptions on the same day as the upper respiratory tract infection consultation.

The highest number of antibiotic prescriptions was for patients between the ages of 12 and 17, and the increase in antibiotic prescriptions for upper respiratory tract infections was the highest in London.

During the pre-COVID-19 period, the upper respiratory tract infection consultation rates exhibited a 43.5% decrease between December 2014 and December 2019. However, there were seasonal changes in the consultation rates, with upper respiratory tract infections peaking in winter. The results indicated that the consultation rates for upper respiratory tract infections decreased significantly after the implementation of COVID-19 mitigation measures, which the authors believe could be due to the practice closures and the reluctance of patients to access healthcare facilities due to the perceived COVID-19 risk.

However, the sustained increase in antibiotic prescriptions till May 2022 indicated a change in antibiotic prescription trends. One possible explanation for the increase in antibiotic prescriptions for upper respiratory tract infections could be the uncertainty in the diagnosis based on remote clinical assessments, which is supported by the finding that antibiotic prescription rates for remote consultations were higher than those for in-person or face-to-face consultations.

Conclusions

Overall, the findings suggested a persistent increase in the number of antibiotic prescriptions for upper respiratory tract infections in the U.K. during the COVID-19 pandemic. Given the increase in antibiotic resistance due to the overuse of antibiotics, it is imperative to reduce the inappropriate prescription of antibiotics for self-limiting viral infections such as upper respiratory tract infections.