A systematic review and meta-analysis shows that influenza vaccination is associated with significantly reduced antibiotic use, while the effect of pneumococcal vaccination is less pronounced, Dutch researchers reported today in Antimicrobial Resistance and Infection Control.
Reviewing literature published from 1998 through 2021, researchers from the Netherlands Institute for Health Services Research included 29 randomized controlled trials (RCTs) and 69 observational studies in their meta-analysis. Most studies were performed in high-income countries in Europe and the Americas, and outcome measures included the proportion of people receiving antibiotics, the number of antibiotic courses or prescriptions per person, and days of antibiotic use. Results were stratified by global region and age-group.
The RCTs showed that the effect of influenza vaccination on the number of antibiotic prescriptions or days of antibiotic use (ratio of means [RoM], 0.71; 95% confidence interval [CI], 0.62 to 0.83) is stronger compared to the effect of pneumococcal vaccination (RoM, 0.92; 95% CI, 0.85 to 1.00) and confirmed a reduction in the proportion of people receiving antibiotics after flu vaccination (risk ratio [RR], 0.63; 95% CI 0.51 to 0.79). The effect of flu vaccination in Europe and the Americas ranged from 0.63 and 0.87 RoM to 0.70 and 0.66 RR, respectively. The evidence from observational studies supported these findings but presented a less consistent picture.
These interventions need to be integrated into a multi-pronged strategy that takes into account all of the other factors that can reduce antibiotic use over time.
The study authors say the stronger effect of the flu vaccine on antibiotic use is surprising, given that flu should not be treated with antibiotics and that the vaccine effectiveness (VE) of pneumococcal vaccines is considerably higher than the VE of influenza vaccines. Still, they say that both vaccines should be used as a possible public health intervention to address antimicrobial resistance.
"These interventions need to be integrated into a multi-pronged strategy that takes into account all of the other factors that can reduce antibiotic use over time, such as antibiotic stewardship policies, raised awareness about rational antibiotic use through antibiotic campaigns and/or access to antimicrobials," they wrote.