An updated analysis of US outpatient antibiotic prescribing during the COVID-19 pandemic suggests a return to prepandemic levels in 2022, Centers for Disease Control and Prevention researchers reported today in Antimicrobial Stewardship & Healthcare Epidemiology.

The analysis of the IQVIA National Prescription Audit Extended Insights database, which includes records of all antibiotic prescriptions dispensed from 48,900 US retail pharmacies, found that the total volume of antibiotic prescriptions, compared with the baseline year of 2019, decreased by 19.4% in 2020 (to 201.3 million prescriptions per 1,000 persons), 15.4% in 2021 (211.1 million prescriptions/1,000 persons), and 5.5% in 2022 (235.8 million prescriptions/1,000 persons). 

But from July to September 2022, prescribing volume approached levels seen during the same period in 2019, then exceeded those levels by 3.6% from October to December 2022.

The largest decrease in prescribing over the study period was observed in children, who in May 2020 received 66% less antibiotics than they received in the baseline period. But children also saw the largest increases in quarterly prescribing rates throughout 2021 and 2022. From October to December 2022, the prescribing rate in children exceeded the adults prescribing rate by 17%.

Respiratory virus season may be playing a role

The authors suggest the uptick of influenza, respiratory syncytial virus (RSV), and COVID-19 in late 2022 likely contributed to the observed trends in antibiotic prescribing, even though antibiotics aren't indicated for those conditions. They also note that a recent study of antibiotic prescribing in primary care settings in the United Kingdom showed similar trends. 

"Our findings highlight the need for enhanced stewardship efforts and support in the outpatient setting during respiratory virus season," they wrote. "Sustained improvement will require increased access to stewardship expertise and the implementation of multifaceted stewardship interventions adapted to urgent care and telemedicine settings."

Our findings highlight the need for enhanced stewardship efforts and support in the outpatient setting during respiratory virus season.

A study conducted in Wales found increased mortality in women with Staphylococcus aureus bacteremia (SAB), with sepsis-related mortality identified as the underlying cause of the disparity, researchers reported yesterday in JAMA Network Open.

Using a database of anonymized, population-scale electronic health record data, researchers from Cardiff University examined data on all adults diagnosed as having SAB from April 2010 through March 2022. They compared all-cause mortality within 30 and 90 days among men and women using logistic regression adjusted for covariates, including age, hospital- or community-related SAB, methicillin resistance, and Charlson comorbidity index score.

The 7,515 adults with SAB identified for the study included 4,755 (63%) male patients and 2,760 (37%) female patients. Overall mortality at 30 days after SAB was 2,057 deaths (27%), including 1,262 among men (27%) and 795 among women (29%). Overall mortality at 90-day post-SAB mortality was 2,712 (36%), including 1,690 (36%) among men and 1,022 (37%) among women.

Further research into underlying factors is needed

In adjusted models, female sex was associated with both 30-day (odds ratio [OR], 1.19; 95% confidence interval [CI], 1.06 to 1.34) and 90-day (OR, 1.15; 95% CI, 1.03 to 1.29) mortality. Using an adjusted competing risks regression model for 30-day mortality, female sex was associated with SAB deaths due to sepsis (hazard ratio, 1.21; 95% CI, 1.02 to 1.44) but not with other causes (hazard ratio, 1.10; 95% CI, 0.99 to 1.23).

The study authors say the findings reaffirm the results of a systematic review and meta-analysis published in February in the same journal.

"Further research is necessary to investigate underlying pathophysiological, social, and health care–related factors that underpin sex-related mortality differences in SAB," they wrote. "Addressing these disparities could lead to more targeted therapies, improved survival rates, and more equitable health care outcomes for both sexes."

Drug supply chain disruptions led to significant shortages in the United States more often than in Canada from 2017 to 2021, a study today in JAMA suggests.

A University of Toronto–led research team used the IQVIA Multinational Integrated Data Analysis database to identify drug supply chain problems and shortages less than 6 months apart in the United States and Canada from 2017 to 2021. The IQVIA database contains information on 89% of US and 100% of Canadian drug purchases.

A shortage was defined as a decrease of at least 33% in monthly purchased standardized drug units within 1 year, relative to those in the 6 months before the report of supply chain issues to a US or Canadian reporting system.

International cooperation needed

A total of 104 drug supply chain issues occurred in both countries, and within 1 year, 49.0% (95% confidence interval [CI], 39.3% to 59.7%) were tied to significant drug shortages in the United States, compared with 34.0% (95% CI, 25.0% to 45.0%) in Canada (adjusted hazard ratio [aHR], 0.53; 95% CI, 0.36 to 0.79).

These findings inform ongoing policy development and highlight the need for international cooperation between countries to curb the effects of drug shortages and improve the resiliency of the supply chain for drugs.

The lower risk of drug shortages in Canada compared with the United States was consistent before (aHR, 0.47; 95% CI, 0.30 to 0.75) and after the COVID-19 pandemic (aHR, 0.31; 95% CI, 0.15 to 0.66). Combining reports of supply chain disruptions in both countries revealed that the shortage risk was double for sole-source drugs (adjusted HR, 2.58; 95% CI, 1.57 to 4.24) and nearly half for Canadian tier 3 drugs (adjusted HR, 0.56; 95% CI, 0.32 to 0.98).

"Drug-related reports of supply chain issues were 40% less likely to result in meaningful drug shortages in Canada compared with the US," the study authors wrote. "These findings inform ongoing policy development and highlight the need for international cooperation between countries to curb the effects of drug shortages and improve the resiliency of the supply chain for drugs."