The number of US outpatient antibiotic prescriptions dispensed in the first 5 months of the coronavirus disease 2019 (COVID-19) pandemic was markedly lower than seasonally expected, according to an analysis published in Clinical Infectious Diseases.

To assess how antibiotic prescribing changed during the COVID-19 pandemic, investigators analyzed data from the IQVIA Total Patient Tracker (TPT), which covers 92% of all retail prescriptions, to estimate the monthly number of unique patients who received antibiotic prescriptions from retail pharmacies between January, 2017, and May, 2020. Only systemic (oral or parenteral) antibiotics were included.

From January to May, 2020, outpatient antibiotic prescriptions exceeded expected seasonal decreases by 33 percentage points, or 6.6 million fewer patients than seasonally expected, compared to the same periods from 2017 to 2019. The largest trend gaps occurred in April (-39%) and May (-42%).

Investigators stratified data by age group. Decreased prescriptions for children aged 19 years or younger was double that of adults aged 20 to 64 years (-31.4 vs -14.4 patients with antibiotic prescriptions per 1000 persons). Among children, decreases were greater in those aged 4 years or younger compared with those 5 to 19 years of age (-41.3 vs -28.3 patients per 1000 persons). Decreases also exceeded expectations in adults 65 years and older compared with adults aged 20 to 64 (-21.7 vs -14.4 patients per 1000 persons).

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Notable decreases from January to May, 2020, were seen in antibiotics prescribed for dentistry, surgical prophylaxis, and respiratory infections. Azithromycin prescriptions increased by 5% from February to March, 2020, exceeding the historical average in New York (37%), New Jersey (32%), and 9 other states, then decreased overall by 71% from March to May 2020.

The IQVIA TPT dataset did not contain aggregated data for all antibiotic classes, so investigators chose to select commonly used agents to analyze major trends.

Investigators commented that the current trend might be due either to COVID-19 disease transmission prevention measures or to a decrease in unnecessary antibiotic prescriptions.

“Prior to the COVID-19 pandemic, at least one-third of outpatient antibiotic prescriptions were considered unnecessary,” the authors wrote, encouraging continued outpatient antibiotic stewardship efforts to ensure appropriate antibiotic use and patient safety.

Disclosure: Several authors reported conflicts of interest as consultants for the US Center for Disease Control and Prevention, which funded the study. Please see the original reference for a full list of the authors’ disclosures.


King LM, Lovegrove MC, Shehab N, et al. Trends in U.S. outpatient antibiotic prescriptions during the COVID-19 pandemic. Clin Infect Dis. Published online December 29, 2020. doi:10.1093/cid/ciaa1896