Concerns Raised Over Volume of Antibiotic Prescriptions for Older Adults With COVID-19 at Outpatient Visits

During the first year of the COVID-19 pandemic, antibiotics were prescribed at approximately 30% of outpatient visits for COVID-19 infection among Medicare beneficiaries, indicating a need to improve antibiotic stewardship among older adults. These findings, from a research letter, were published in JAMA.

Researchers assessed the rate of antibiotics prescribed at outpatient visits among older adults (≥65 years) with COVID-19 infection between April 2020 and April 2021 using data from Medicare carrier claims and Part D event files. Antibiotics prescribed among patients who received an additional diagnosis for which antibiotic therapy was appropriate on the basis of clinical guidelines were excluded. Chi-square testing was used to compare factors such as age, sex, race/ethnicity, and prescribers’ location between patients who did and did not receive an antibiotic prescription.

Among patients (N=1,169,120) who received a primary diagnosis of COVID-19 infection at an outpatient visit, 29.6% were prescribed antibiotics. The number of antibiotic prescriptions was similar between men and women (29.0% vs 30.1%, respectively), and patients who were non-Hispanic White received the most prescriptions (30.6%) compared with those in other racial/ethnic groups (range, 23.2%-30.1%).

The researchers found that rate of antibiotic prescriptions was most increased at emergency department visits (33.9%), with the lowest rates observed among primary care office visits (23.9%). Azithromycin represented the majority of prescriptions (50.7%), followed by doxycycline (13.0%), amoxicillin (9.4%), and levofloxacin (6.7%). Of azithromycin prescriptions, the majority were received at urgent care centers (60.1%).

This study was potentially limited by misclassification bias, and the researchers did not control for disease severity, underlying comorbidities, or hospitalizations following COVID-19 diagnosis.

According to the researchers, “these observations reinforce the importance of improving appropriate antibiotic prescribing in outpatient settings and avoiding unnecessary antibiotic use for viral infections such as COVID-19 in older adult populations.”

Disclosure: Some authors declared affiliations with industry. Please see the reference for a full list of disclosures.

Reference

Tsay SV, Bartoces M, Gouin K, Kabbani S, Hicks LA. Antibiotic prescriptions associated with COVID-19 outpatient visits among medicare beneficiaries, April 2020 to April 2021. Published online April 8, 2022. JAMA. doi.10.1001/jama.2022.5471