Impact of the COVID-19 pandemic on the utilisation and quality of antibiotic use in the Scottish primary care setting: a population-based segmented interrupted time-series analysis

Inappropriate use of antibiotics is expected to increase during the COVID-19 pandemic, but there are limited data on COVID-19’s long-term impact. We assessed the impact of COVID-19 on the quantity and quality of antibiotic use in Scotland. A segmented interrupted time series was applied to monthly dispensed antibiotics using prescription cost analysis data from March/2019 to March/2023. Antibiotic use was quantified using the number of items dispensed/1000 inhabitants (TIDs) and defined daily dose/1000 inhabitants/day (DIDs). The quality of antibiotic use was assessed using key quality indicators including the WHO AWaRe classification, proportion of broad-spectrum and ”4C”-antibiotics. Overall, for all antibiotics, there was a non-significant increase in TIDs and DIDs before the first lockdown (March/2020) (β₁), but a decline in the level immediately after the first (β₂) and second lockdowns (β₄) (November/2020), albeit non-significant. However, a significant increase in the time trend after the second lockdown (β₅) for all antibiotic classes was observed. COVID-19 had no negative impact on AWaRe utilisation, with the proportion of all antibiotics from the Access group increasing from 76% in March/2019 to 90% in March/2023. The proportion of ”4C” antibiotic reduced significantly after the second lockdown. Neither the utilisation nor the quality of total antibiotic use appeared to have been significantly affected by COVID-19.