Antibiotics for COVID-related visits more common in adults

Pills spilling from bottle

sasirin pamai / iStock

An analysis of US health insurance claims found that receipt of antibiotics for COVID-19–related outpatient visits was more common in adults than children and adolescents during the first 2 years of the pandemic, researchers reported today in JAMA Health Forum.

For the study, researchers with the University of Pittsburgh School of Medicine and Harvard Medical School analyzed deidentified commercial health insurance claims data from COVID-19–related outpatient visits for people ages 0 to 64 years from Apr 1, 2020, to May 31, 2022. Visits with a co-diagnosis for which antibiotics might be appropriate were excluded from the analysis. The remaining visits were classified as in-person physician office, practice-based telemedicine, direct-to-consumer telemedicine, emergency department (ED), or other.

Antibiotics most commonly prescribed during ED, telemedicine visits

A total of 1,293,303 adult visits and 177,057 child and adolescent visits were in included in the analysis. Antibiotic receipt ranged from 4% in children ages 0 to 5 to 16% in adults ages 45 to 65, with roughly 12% of 6- to 17-year-olds and 25- to 44-year-olds receiving an antibiotic during a COVID-19–related visit. COVID-19–related visits accounted for 20% of acute respiratory tract infection (ARTI)–related visits and 7% of ARTI-related antibiotic prescriptions.

Antibiotic receipt varied by site of care, with the highest rates observed in practice-based telemedicine and ED visits for all groups except ages 0 to 5; for that group, antibiotic receipt was highest in direct-to-consumer telemedicine visits. Antibiotic receipt also varied by region, with the highest rate seen in the South (15%), followed by the West (9%), Midwest (9%), and Northeast (7%).

Amoxicillin was the most common antibiotic prescribed to children under 6 (37%), followed by azithromycin (36%), while azithromycin was more commonly prescribed to those ages 6 to 17 years and adults (68% and 70%, respectively) than amoxicillin (15% and 4%).

The study authors say the results are consistent with a previous study that examined Medicare claims in outpatient visits for COVID-19. That study found nearly 30% of COVID-19 visits by Medicare beneficiaries 65 and older were associated with receipt of antibiotics. More than half of those antibiotic prescriptions (50.7%) were for azithromycin, which in the early months of the pandemic was thought to help COVID-19 patients but was ultimately found to have no benefit.

They suggest increased antibiotic prescribing in adults may be linked to higher prevalence of comorbidities and higher risk of adverse outcomes from COVID-19—even though antibiotics aren't indicated for or effective against COVID-19.

"Understanding these prescribing practices will inform efforts to improve antibiotic stewardship," they wrote.

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