Community antibiotic prescriptions during COVID-19 era: a population-based cohort study among adults

Bat Sheva Gottesman, Marcelo Low, Doron Netzer, Ronit Almog, Michal Chowers

Research output: Contribution to journalArticlepeer-review


Objectives: This study investigated the association between the COVID-19 pandemic and antibiotic prescription ratios and the determinants of antibiotic prescription in the community. Methods: The study was based on a retrospective population cohort of adults in a community setting. Antibiotic prescription ratios from March 1, 2020 to February 28, 2021 (COVID-19 period) were compared to similar months in previous years. Differences in visit type, infectious disease–related visit, and antibiotic prescription ratios during these visits were compared. A logistic regression model was used to identify independent determinants of antibiotic prescription during the study period. Results: The cohort included almost 3 million individuals with more than 33 million community medical encounters per year. In the COVID-19 period, the antibiotic prescription ratio decreased 45% (from 34.2 prescriptions/100 patients to 19.1/100) compared to the previous year. Visits due to an infectious disease etiology decreased by 10% and prescriptions per visit decreased by 39% (from 1 034 425 prescriptions/3 764 235 infectious disease visits to 587 379/3 426 451 respectively). This decrease was observed in both sexes and all age groups. Telemedicine visits were characterized by a 10% lower prescription ratio compared to in-person visits. Thus, a threefold increase in telemedicine visits resulted in a further decrease in prescription ratios. The COVID-19 period was independently associated with a decrease in antibiotic prescription, with an OR of 0.852 (95% CI 0.848–0.857). Discussion: We describe a significant decrease in antibiotic prescription ratios during the COVID-19 periods that was likely related to a decrease in the incidence of certain infectious diseases, the transfer to telemedicine, and a change in prescription practices among community-based physicians.

Original languageEnglish
Pages (from-to)1134-1139
Number of pages6
JournalClinical Microbiology and Infection
Issue number8
StatePublished - Aug 2022

Bibliographical note

Funding Information:
In addition to the decline in the number of ID visits, fewer visits resulted in antibiotic prescription. This phenomenon was more pronounced in viral-related aetiologies, such as URTIs, as reported by Mamun et al. [ 15 ]. A possible explanation is greater awareness of viral pathogens, which increased physician and public acceptance of the inefficacy of antibiotics against viruses. This is supported by the extremely low antibiotic prescription for COVID-19–related visits (1%), whereas little change was noted in the antibiotic prescription ratio for UTI, a bacterial disease. Of note, this is in sharp contrast to a report from London, England, where 31% of patients diagnosed with COVID-19 received an antibiotic prescription within 14 days of diagnosis [ 16 ].

Publisher Copyright:
© 2022 European Society of Clinical Microbiology and Infectious Diseases


  • Antibiotic prescription
  • Community
  • COVID-19
  • Infectious diseases
  • Telemedicine

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases


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