Determining the impact of the COVID-19 pandemic on the consumption of antibiotics in Shaanxi Province, China: An interrupted time series analysis

Wenjing Ji ¹ Yifei Zhao ^1* Jiaxi Du ¹ Hang J Zhao ^1* David J McIver ^2* Dan Ye ^3* Kangkang Yan ^3* Xiaolin Wei ⁴ Yu Fang ¹

• ¹ Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, China
• ² Institute for Global Health Sciences, University of California, San Francisco, San Francisco, California, United States
• ³ Department of Pharmacy, Xi'an No.3 Hospital, the Affiliated Hospital of Northwest University, Xi’an, China
• ⁴ Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada

The COVID-19 pandemic, as well as associated prevention and control measures, have impacted the entire health care system, including the use patterns of medicine. However, the impact of COVID-19 on the use of antibiotics has not yet been extensively evaluated in China. This study aimed to evaluate the impact of the pandemic on the consumption and expenditure in public healthcare institutions of antibiotics in Shaanxi province, China.We used longitudinal data from the Shaanxi provincial drug procurement database in this study. An interrupted time-series analysis was performed to evaluate the effects of the COVID-19 on antibiotics consumption and expenditures in public healthcare institutions in Shaanxi from 1 January 2017 to 31 December 2020. Antibiotic consumption was expressed as the number of defined daily doses (DDDs) per 1,000 residents per day (DID), based on the population of Shaanxi province at the end of each year from the National Bureau of Statistics. The pre-pandemic period was from January 2017 to January 2020 and the post-pandemic period was from February 2020 to December 2020.A declining trend in antibiotic consumption was observed immediately following the COVID-19 pandemic (β2 = -4.099; p < 0.001). Regarding the route of administration, a larger decrease in the consumption of oral antibiotics was observed compared to parenteral (β2 = -3.056; p < 0.001). The decrease in antibiotic consumption in the Watch category (β2 = -2.164; p < 0.001) was larger than in the Access category (β2 = -1.773; p < 0.001), and Penicillins (J01C) (β2 = -1.261; p < 0.001) showed a higher decline compared to cephalosporins (J01D) (β2 = -1.147; p < 0.001). An increasing trend of broad-spectrum antibiotic consumption was observed after the onset of the pandemic (β3 = 0.021; p = 0.015). Expenditures on and consumption of antibiotics follow essentially the same trend.Despite an initial decline on the antibiotic consumption at the start of the COVID-19 pandemic, it had returned to prior levels by the end of 2020. Findings underscore the continued importance of antibiotic stewardship initiatives.