The impact of COVID-19 on outpatient antibiotic prescriptions in Ontario, Canada; an interrupted time series analysis

Background — The COVID-19 pandemic has potentially impacted outpatient antibiotic prescribing. Investigating this impact may identify stewardship opportunities in the ongoing COVID-19 period and beyond.

Methods — We conducted an interrupted time series analysis on outpatient antibiotic prescriptions and antibiotic prescriptions/patient visits in Ontario, Canada between January 2017 and December 2020 to evaluate the impact of the COVID-19 pandemic on population-level antibiotic prescribing by prescriber’s specialty, patient demographics and conditions.

Results — In the evaluated COVID-19 period (March-December 2020), there was a 31.2% [95% CI: 27.0%–35.1%] relative reduction in total antibiotic prescriptions. Total outpatient antibiotic prescriptions decreased during the COVID-19 period by 37.1% [32.5%–41.3%] among family physicians, 30.7% [25.8%–35.2%] among sub-specialist physicians, 12.1% [4.4%–19.2%] among dentists and 25.7% [21.4%–29.8%] among other prescribers. Antibiotics indicated for respiratory infections decreased by 43.7% [38.4–48.6%]. Total patient visits and visits for respiratory infections decreased by 10.7% [5.4%–15.6%] and 49.9% [43.1%%–55.9%]). Total antibiotic prescriptions/1,000 visits decreased by 27.5% [21.5%–33.0%], while antibiotics indicated for respiratory infections/1,000 visits with respiratory infections only decreased by 6.8% [2.7%–10.8%].

Conclusion — The reduction in outpatient antibiotic prescribing during the COVID-19 pandemic was driven by less antibiotic prescribing for respiratory indications and largely explained by decreased visits for respiratory infections.