Increased sales of these antibiotics during the COVID-19 pandemic raise concerns about the growing threat of antimicrobial resistance.
Antimicrobial resistance (AMR) is a preeminent threat to global health. AMR is driven by the overuse or unnecessary use of antibiotics, as dangerous pathogens can mutate to resist antibiotics after repeated exposure.
The World Health Organization (WHO) created a Watch list to designate certain powerful antibiotics that should be used less frequently to reduce the risk of AMR. Global per capita consumption of these Watch antibiotics increased by 91% from 2000-2015; it is significant to note, however, that Watch antibiotic consumption increased 165% in low- and middle-income countries, while only increasing 28% in high-income countries.
This overconsumption of antibiotics seemingly increased during the COVID-19 pandemic. Approximately 75% of COVID-19 patients were prescribed antibiotics, despite less than 10% of patients diagnosed with a with a secondary bacterial infection that required antibiotics.
A new study, published in The Lancet, is the first to study the full effect of the COVID-19 pandemic on antimicrobial consumption. The investigators examined the associations between COVID-19 infections and vaccinations with global antibiotic sales during the first 2 years of the COVID-19 pandemic.
The investigators obtained country-level broad-spectrum oral antibiotic sales data from the IQVIA MIDAS database. They utilized reported monthly sales of 4 broad-spectrum antibiotics: cephalosporins, penicillins, macrolides, and tetracyclines.
From January 2018-May 2022, the investigators examined global trends in antibiotic sales across 71 countries. Their regression analysis comprised of the pandemic period, March 2020-May 2022.
These antibiotic sales data were combined with country-level COVID-19 statistics from Our World in Data (OWD). With population data from OWD, the investigators converted the monthly aggregate antibiotic sales volume data from MIDAS into monthly sales per 1000 people. They also aggregated the number of new COVID-19 infections and vaccinations into monthly data expressed per 1000 people.
Shortly after the onset of the pandemic, during April and May 2020, sales of all 4 antibiotics dipped dramatically. In June 2020, sales began to increase again and gradually returned to pre-pandemic levels.
In fixed-effects regression models, a 10% increase in monthly COVID-19 cases was associated with 0.2%–0.3% higher sales of cephalosporins, 0.2%–0.3% higher sales of penicillins, 0.4%–0.6% higher sales of macrolides, and 0.3% higher sales of all four antibiotics combined per 1000 people.
Broken down by continent, a 10% increase in monthly COVID-19 infections was associated with higher macrolides sales of 0.8% in Europe, 1.3% in North America, and 1.5% in Africa. Sales of other antibiotics by continent were also positively correlated with COVID-19 cases, albeit with a relatively smaller association. Notably, there was no consistent correlation between antibiotic sales and COVID-19 vaccinations.
Because of the robust findings that antibiotic sales increased alongside COVID-19 infections, the investigators emphasized the importance of antimicrobial stewardship. They wrote, “COVID-19 will likely become endemic eventually and similarly virulent as the common cold, and medical guidelines and government policies must stop it from becoming another influenza-like illness for which antibiotics are continually and inappropriately prescribed.”