Evaluation of duration of antibiotic therapy across hospitals in Scotland including the impact of COVID-19 pandemic: a segmented interrupted time series analysis

Little is known about the duration of antibiotic use in hospital settings. We evaluated the duration of hospital antibiotic therapy for four commonly prescribed antibiotics (amoxicillin, co-amoxiclav, doxycycline, and flucloxacillin) including the assessment of COVID-19 impact. A repeated, cross-sectional study using the Hospital Electronic Prescribing and Medicines Administration system (January/2019-March/2022). Monthly median duration of therapy/duration categories was calculated, stratified by routes of administration, age, and sex. The impact of COVID-19 was assessed using segmented time-series analysis. There were significant variations in the median duration of therapy across routes of administration (P < 0.05), with the highest value among those antibiotic courses composed of both oral and IV antibiotics (‘Both’ group). Significantly higher proportions of prescriptions within the ‘Both’ group had a duration of >7 days compared to oral or IV. The duration of therapy differed significantly by age. Some small statistically significant changes in the level/trends of duration of therapy were observed in the post-COVID-19 period. No evidence for prolonged duration of therapy were observed, even during COVID-19 pandemic. The duration of IV therapy was relatively short, suggesting timely clinical review and consideration of IV to oral switch. Longer duration of therapy was observed among older patients.

目前学界对医疗机构内抗生素使用时长的相关认知仍较为有限。本研究针对临床常用的四种抗生素（阿莫西林[amoxicillin]、阿莫西林克拉维酸钾[co-amoxiclav]、多西环素[doxycycline]以及氟氯西林[flucloxacillin]）的住院抗菌治疗时长展开评估，同时分析新冠疫情（COVID-19）带来的影响。本研究采用重复横断面研究设计，依托医院电子处方与药品管理系统（Hospital Electronic Prescribing and Medicines Administration system）开展，数据覆盖2019年1月至2022年3月。研究计算了每月的治疗时长中位数及时长区间，并按给药途径、患者年龄与性别进行分层分析。采用分段时间序列分析方法评估新冠疫情的影响。不同给药途径的抗菌治疗中位数时长存在显著差异（P<0.05），其中同时采用口服与静脉给药的联合给药组（‘Both’组）的时长最高。联合给药组中，治疗时长超过7天的处方占比显著高于单纯口服或单纯静脉给药组。患者年龄不同，抗菌治疗时长也存在显著差异。新冠疫情后时期，治疗时长的水平与趋势出现了小幅且具有统计学意义的变化。即便在新冠疫情大流行期间，也未观察到治疗时长延长的相关证据。静脉给药的治疗时长相对较短，提示临床应及时开展评估并考虑将静脉给药转换为口服给药；老年患者的抗菌治疗时长普遍更长。