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.

预期新冠疫情期间抗生素的不合理使用会有所增加，但目前关于新冠疫情长期影响的相关数据仍较为有限。本研究评估了新冠疫情对苏格兰地区抗生素使用量与使用质量的影响。
本研究采用分段中断时间序列（segmented interrupted time series）分析方法，基于2019年3月至2023年3月的处方成本分析数据，对苏格兰地区月度抗生素配药量进行分析。抗生素使用量以每千居民配药件数（TIDs）及限定日剂量每千居民每日（DIDs）进行量化；抗生素使用质量则通过关键质量指标评估，包括世界卫生组织（World Health Organization, WHO）AWaRe分类、广谱抗生素占比以及“4C”抗生素（”4C”-antibiotics）占比。
整体而言，在首次封控（2020年3月）前，所有抗生素的TIDs与DIDs均呈现非显著性上升（β1）；而在首次封控后（β2）及第二次封控（2020年11月，β4）后，抗生素使用量水平虽出现下降，但均未达到显著性水平。不过，第二次封控后，所有抗生素类别的时间趋势均出现显著性上升（β5）。新冠疫情未对AWaRe分类的抗生素使用情况产生负面影响，可及组抗生素占比从2019年3月的76%提升至2023年3月的90%。“4C”抗生素占比则在第二次封控后出现显著下降。
总体而言，苏格兰地区抗生素的总使用量与使用质量均未受到新冠疫情的显著影响。