An analysis of data from 71 countries shows that over the first 2 years of the pandemic, antibiotic sales increases were linked with increases in COVID-19 cases, researchers reported last week in eClinical Medicine.
Using the IQVIA MIDAS database, researchers with One Health Trust, GlaxoSmithKline, and the Harvard TH Chan School of Public Health obtained monthly sales volume data on broad-spectrum antibiotics (cephalosporins, penicillins, macrolides, and tetracycline) in 71 countries from March 2020 to May 2022. They then combined those figures with country-month-level COVID-19 case and vaccination data to estimate the association between antibiotic sales volumes and COVID-19 cases and vaccinations per 1,000 people over the same period.
Sales of all four antibiotics fell sharply during April and May 2020 compared with the pre-pandemic period (January 2018 to March 2020), followed by a gradual rise to near pre-pandemic levels through May 2022. In fixed-effects regression models, a 10% increase in monthly COVID-19 cases was associated with 0.27% higher sales of cephalosporins, 0.33% higher sales of penicillins, 0.45% higher sales of macrolides, and 0.32% higher sales of all four antibiotics combined per 1,000 people. No associations were observed with tetracyclines.
Across continents, a 10% increase in monthly COVID-19 cases was associated with 0.78%, 1.33%, and 1.48% higher macrolides sales in Europe, North America, and Africa respectively. Sales of other antibiotics across continents were also positively associated with COVID-19 cases, although the estimated associations were smaller in magnitude. No consistent associations were observed between antibiotic sales and COVID-19 vaccinations.
Opportunity for stewardship
The authors note that while the findings indicate a level of antibiotic overuse and misuse for COVID-19, pandemic-associated lockdowns and other non-pharmaceutical interventions likely kept the increase in antibiotic sales modest by reducing non-COVID infections that drive antibiotic use.
Preventing unnecessary treatment of COVID-19 cases with antibiotics remains essential.
"However, preventing unnecessary treatment of COVID-19 cases with antibiotics remains essential," they wrote. "COVID-19 will likely become endemic eventually and similarly virulent as the common cold, and medical guidelines and government policies must stop it from becoming another influenza-like illness for which antibiotics are continually and inappropriately prescribed."