The impact of COVID-19 on community antibiotic use in Canada: an ecological study.

Abstract Objectives The COVID-19 pandemic has impacted the incidence of infectious diseases and medical care. This study aimed to describe the impact of the COVID-19 pandemic on community-level antibiotic use. Methods Using national antibiotic dispensing data from IQVIA’s CompuScript database, this ecological study investigated antibiotic dispensing through community retail pharmacies in Canada from November 2014 to October 2020. Analyses were stratified by age, sex, prescription origin, and approximate indication. Results Adjusting for seasonality, the national rate of antibiotic dispensing in Canada decreased by 26.5% (50.4 to 37.0 average prescriptions per 1,000 inhabitants) during the first eight months of the Canadian COVID-19 period (March to October 2020), compared to the pre-COVID-19 period. Prescribing rates in children ≤18 years decreased from 43.7 to 12.2 prescriptions per 1,000 inhabitants in males (-72%) and from 46.8 to 14.9 prescriptions per 1,000 inhabitants in females (-68%) in April 2020. Rates in adults ≥65 decreased from 74.9 to 48.8 prescriptions per 1,000 inhabitants in males (-35%) and from 91.7 to 61.3 prescriptions per 1,000 inhabitants in females (-33%) in May 2020. Antibiotic prescriptions from family physicians experienced a greater decrease compared to surgeons and infectious disease physicians. Prescribing rates for antibiotics for respiratory indications decreased by 56% in May 2020 (29.2 to 12.8 prescriptions per 1,000 inhabitants), compared to prescribing rates for urinary tract infections (9.4 to 7.8 prescriptions per 1,000 inhabitants; -17%) and skin and soft tissue infections (6.4 to 5.2 prescriptions per 1,000 inhabitants; -19%). Conclusions The first eight months of the COVID-19 pandemic reduced community antibiotic dispensing by 26.5% in Canada, compared to the marginal decrease of 3% in antibiotic consumption between 2015 and 2019. Further research is needed to understand the implications and long-term effects of the observed reductions on antibiotic use on antibiotic resistance in Canada.