Antibiotic use in township hospitals during the COVID-19 pandemic in Shandong, China

Abstract

Abstract Background The overuse of antibiotics in primary healthcare settings (PHSs) has caused a serious public health problem in China. The Coronavirus Disease-19 (COVID-19) pandemic outbreak has brought about dramatic changes in the supply of and demand for medical services in PHSs, possibly resulting in unprecedented changes in antibiotic use. Objective This study aims to assess the immediate and long-term impacts of the COVID-19 pandemic on the changes in antibiotic consumption in PHSs. Method From January 2019 to December 2021, the data on antibiotic consumption were collected from selected township hospitals in Shandong, China. Antibiotic consumption was quantified by using the defined daily doses (DDDs) and the WHO Access, Watch, Reserve category. A Segmented regression model was established to analyze the immediate and long-term impacts of the COVID-19 pandemic on antibiotic use by using the interrupted time series analysis. Results The total antibiotic consumption on all PHSs decreased from 170.36 (DDDs in ten thousand) in 2019 to 128.86 (DDDs in ten thousand) in 2020/2021 with a 24.36% reduction under the COVID-19 pandemic. Over the entire study period, the use of penicillins (J01C) and cephalosporins (J01D) accounted for more than 50% of total antibiotic consumption. The average annual consumption of Watch category antibiotics in 2020/2021 down by 37.74% compared to that in 2019. According to the interrupted time series analysis, the total antibiotic consumption decreased significantly immediately after the COVID-19 pandemic outbreak (coef. =-2.712, p = 0.045) and then increased significantly month-over-month in the long-term (coef. =0.205, p = 0.005). Additionally, the consumption of Access category antibiotics increased significantly in PHSs in the log-term (coef. =0.136, p = 0.018), while the consumption of Watch category antibiotics declined sharply immediately (coef. =-1.222, p < 0.001) after the pandemic but increased slightly over the long-term (coef. =0.073, p = 0.001). Conclusion The extensive use of penicillin and cephalosporins should be of great concern. After the outbreak of COVID-19 pandemic, the total antibiotic consumption decreased generally and the use pattern was improved to some extent in the PHSs in Shandong, China. This provides an opportunity to improve the abuse of antibiotic in PHSs in China.