Association of changes in seasonal respiratory virus activity and ambulatory antibiotic prescriptions with the COVID-19 pandemic
JAMA — Lepak AJ, Taylor LN, Stone CA, et al. | June 23, 2021
Numerous measures have been implemented to reduce the spread of SARS-CoV-2, which may have unintended positive associations with decreasing other respiratory infections. Considering that inappropriate prescription of antibiotics is frequently made for viral respiratory diseases, researchers herein hypothesized that a reduced respiratory virus incidence would be associated with reduced ambulatory antibiotic orders. A pre-post study was performed that consisted of a pre–COVID-19 pandemic period (July 2018 to February 2020), a 1-month run-in period (March 2020), and a COVID-19 pandemic period (April 2020 to February 2021). Weekly statewide surveillance polymerase chain reaction data were obtained from the Wisconsin State Laboratory of Hygiene, for the following respiratory viruses: influenza, respiratory syncytial virus, human parainfluenza virus, human metapneumovirus, seasonal coronavirus, adenovirus, and enterovirus/rhinovirus. They obtained ambulatory antibiotic prescribing data for all University of Wisconsin Health ambulatory clinics, visit types (eg, in person, telemedicine, and telephone), and ages. In line with their hypothesis, researchers identified a marked reduction in respiratory virus detections, with a concomitant 79% reduction in ambulatory antibiotic prescribing rates for respiratory tract infections, during the COVID-19 pandemic. This study is identified to be the first work to combine respiratory virus activity and antibiotic prescriptions that were indexed to the number of encounters over a prolonged period that includes the typical respiratory virus season. Notably, increased ambulatory antibiotic prescriptions did not appear during COVID-19 surges in Wisconsin (October to December 2020). In addition, they noted a stronger association of noninfluenza virus activity with antibiotic prescription rates. This is possibly due to highly accessible, rapid diagnostics for SARS-CoV-2 and influenza viruses to avoid unnecessary antibiotic prescriptions.
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