Community Antibiotic Use at the Population Level During the SARS-CoV-2 Pandemic in British Columbia, Canada

Mamun, Abdullah A; Saatchi, Ariana; Xie, Max; Lishman, Hannah; Blondel-Hill, Edith; Marra, Fawziah; Patrick, David M

OBJECTIVES: To examine the aggregate rates of antibiotic use at population level and compare these rates over time against historical averages to identify the effect of SARS-CoV-2 and the resulting control measures, upon community prescribing. METHODS: We collected antibiotic prescriptions and physician office visits from January 1, 2016 to July 21, 2020. We calculated monthly prescription rates stratified by sex, age group, profession, diagnosis type and antibiotic class. We looked at monthly prescription rate as a moving average over time. Using interrupted time series analysis method we estimated the changes in prescription rates after March 2020. RESULTS: The moving average of overall monthly prescription rates during January to June of 2020 were below the minimum of the historical years’ moving averages (2016-2019). We observed >30% reduction in overall monthly prescription rates in April, May and July of 2020 compared to the same months of 2019. We observed overall monthly prescription rates experienced a significant level change of -12.79 (p < 0.001) after COVID-19 after March 2020, with the greatest level change of -18.02 among 1-4 years (p<0.001). We estimated an average -5.94 (p<0.001) change in RTI-associated monthly prescription rates after March 2020. Overall prescription rates comparing January – July 2019 and their 2020 counterparts showed a decrease in monthly prescribing ranging from -1 to -5 for: amoxicillin, amoxicillin and enzyme inhibitors, azithromycin, clarithromycin and sulfamethoxazole. CONCLUSION: In BC, Canada, overall and RTI-specific monthly antibiotic prescription rates declined significantly during April to July 2020 compared to the same months in pre-pandemic years.