gms | German Medical Science

Background: The outbreak of the COVID-19 pandemic in March 2020 also led to significant changes in the burden of disease and thus in the medication prescription patterns in Germany. To turn up at work despite flue symptoms, even though it would be appropriate to report sick, used to be daily occurrence, especially among service employees. During the pandemic, instead, this had been viewed much more critically than before due to the general risk of infection. Persons showing flue-like symptoms were suspected as possible candidates for SARS-Co-V-2 virus infection. In most cases, they were requested by the employer to stay at home to prevent them to spread the illness. This effect as well as the public pandemic-related infection protection measures starting in spring 2020 led to fewer respiratory infections and cases of incapacity to work due to infectious diseases.

The problem of excessive use of reserve antibiotics has been discussed in the statutory health insurance for a long time and changes during the pandemic are therefore relevant. Another problem is the delivery bottleneck, especially for antibiotics for children.

Materials and methods: We use medication prescription data from statutory health insurance in Schleswig-Holstein from 2017 till 2022 with approximately 950,000 data records per quarter. These contain pseudonymized IDs for doctors and patients as well as the pharmaceutical central number, the doctor's specialist group, the prescription date and the age of the patient. According to master data in our database, the ATC code (international anatomical-therapeutic-chemical classification with national special features resulting from the approval) is derived from the central pharmaceutical number. The ATC codes of antibiotics we are looking at begin with J01. We consider reserve antibiotics according to the WHO classification.

Results: The overall number of prescriptions fell slightly by 0.3% from 2017 to 2019 in the pre-Corona period and then rose by 8.8% in 2022. The antibiotic prescriptions fell more sharply in the pre-corona period to 88% and in 2020 to 65.5%. A trend reversal is reported for the following years: in 2021, 70.2% of the 2017 value is reached again and in 2022, a value of 98.2% is reported.

In a next step, we consider a measure of polypharmacy as the mean number of drug groups regarding the ATC 7 Codes for all patients and for those patients with antibiotic prescriptions. From 2017 till 2019 there is a stable value of 3.2 different drugs for all patients and of 4.1 of those patients with at least one antibiotic drug. In the central corona years there is a slight increase to 3.3 and a remarkable enlargement to 3.7 in 2022 at the end of the corona pandemic.

A different picture emerges for patients with antibiotic prescriptions: in 2020 there is a significant increase to 4.4, which drops to 4.0 in 2021 and then rises again to 4.6.

The mean age of all drug patients increases from 2017 to 2022 in the pre-Corona period, initially moderately and then more quickly from initially 52.4 to 59.8 years. Patients with antibiotic prescriptions are younger on average: the mean age rises from 46.2 years in 2017 to 51.2 years in 2022.

The number of prescriptions for reserve antibiotics increased by 55.7% from 2017 to 2020 and then in 2022 it was 7.7% lower than in 2017. The two top positions in the prescription numbers of Amoxicillin (J01CA04) and Cefuroxime (J01DC02) have not changed. Position 4 has risen to 3 (Fosfomycin, J01XX01), position 6 to 4 (Amoxicillin and beta-lactase inhibitors, J01CR02) and position 3 has fallen to position 5 (Azithromycin, J01FA10).

Overall, there have been only minor changes in the prescription ranking. At the ATC 5 level there is no change of the first three positions (1: Penicillins with extended spectrum, J01CA, 2: Second-generation cephalosporins, J01DC, 3: Macrolides, J01FA). The same is true at the ATC 4 level.

Conclusion: The number of prescriptions for antibiotics has risen back to the level of 2017 in 2022 after a sharp drop, particularly in 2020 being the first year of the pandemic. This may be related to a changed health situation. Staying at home during the lock-down in 2020 also lowered the number of GP consultations, so maybe the lack of seeking doctor's advice reduced unnecessary antibiotic prescriptions during the Corona period. The increase in the mean age of patients overall for pharmacotherapy and specifically for patients with antibiotic therapy, which goes well beyond demographic changes, indicates problems particularly for middle-aged and older patients. The consequences of the corona pandemic remain a challenge for the health system and will continously represent a focus of research.