It was a time of great uncertainty: when the first coronavirus wave rolled across Switzerland in spring 2020, there were neither diagnostic tests nor a vaccine nor effective medication. During this period of uncertainty, doctors in primary care practices in Switzerland apparently increasingly resorted to antibiotics to treat patients, even though these drugs were ineffective against viruses. This is the conclusion reached by a research team led by Heiner Bucher from the Department of Clinical Research at the University of Basel and University Hospital Basel.
As the team reports in the journal ’Clinical Microbiology and Infection’, the use of antibiotics doubled from around 8 to 16 antibiotic prescriptions per 100 consultations. During the first wave of Sars-CoV-2 at the beginning of 2020, there was a massive increase in antibiotic prescriptions. From spring 2020, these remained at an above-average level for the entire year compared to the previous years 2017 to 2019.
The researchers began their study in 2017 before the pandemic as part of the National Fund Program NRP 72 ’Antimicrobial Resistance’. The study was based on fully anonymized individual patient data from over two million health insurance holders of all age groups as well as billing data from doctors. The researchers investigated the impact of the coronavirus pandemic on prescribing practices, focusing on 2945 general practitioners and paediatricians who had already had a medium to high rate of antibiotic prescriptions in previous years.
Risk of resistanceThe result: the massively increased prescribing practice was evident for all antibiotic classes, including those not primarily intended for the treatment of respiratory tract infections. ’This is particularly worrying, as excessive and incorrect antibiotic use increases the risk of bacteria becoming resistant to the active ingredient used,’ says Heiner Bucher. Multi-resistant bacteria lead to infections that are almost impossible to treat.
According to the researchers’ analysis, the increased prescribing practice was not due to ’blind prescribing’, for example through telephone consultations. The majority of prescriptions were made during consultations in the practice. It was also found that doctors were carrying out more blood tests to detect inflammation in their practices. The most likely explanation for the massive increase in prescriptions is probably the concern that a Covid-19 infection could also lead to bacterial complications. The researchers suspect that the lack of diagnosis and treatment options for Covid-19 also played a role.
Vulnerable patients and patientsThe doctors in the study were primarily confronted with particularly vulnerable patient groups in the first year of the pandemic: While the overall number of consultations in the first year of the pandemic halved compared to previous years, the number of consultations for patients with pre-existing conditions, some of which were severe, doubled.
’In preparation for future pandemics, we must limit the expected massive use of antibiotics with suitable measures such as targeted information strategies in order to reduce unnecessary prescriptions and the risk of resistance,’ emphasizes Heiner Bucher.
The research team now wants to investigate whether prescribing practices have changed again in the years following the pandemic. In collaboration with the Swiss Center for Antibiotic Resistance, it also wants to find out how resistance is developing as a result of the increased use of antibiotics.
Soheila Aghlmandi, Florian S. Halbeisen, Pascal Godet, Andri Signorell, Simon Sigrist, Ramon Saccilotto, Andreas F. Widmer, Andreas Zeller, Julia Bielicki, Heiner C. Bucher
Impact of the COVID-19 pandemic on antibiotic prescribing in high-prescribing primary care physicians in Switzerland
Clinical Microbiology and Infection (2023), doi: 10.1016/j.cmi.2023.11.010