(259) Exploring the Effects of COVID-19 on Antibiotic Consumption Patterns in Iran’s Outpatient Setting: A Cross-Sectional Study

Background: The COVID-19 pandemic has influenced global health and complicated antimicrobial resistance (AMR) management. The pandemic has led to varying antibiotic usage patterns, intensifying global misuse due to the initial lack of treatment protocols.

Objectives: This study aimed to evaluate antibiotic prescription rates in Iran pre and post-COVID-19 flare-up, to inform healthcare decisions and future pandemic readiness.

Methods: This study used urban outpatient insurance data from the Iran Health Insurance Organization to analyze antibiotic use trends in Iran before and during the COVID-19 outbreak. The timeframe from March 21, 2018, to March 20, 2020, was designated as the pre-COVID-19 period, while the period from March 21, 2020, to March 20, 2022, was considered as the COVID-19 pandemic period. The study compared the average monthly antibiotic use in Iran before and during the COVID-19 outbreak using the DDD/1000 inhabitants per year measure. The analysis was done using the one-way Analysis of Variance (ANOVA) test. Data extraction and analysis were performed using Microsoft Excel and IBM SPSS Statistics version 26. A p-value of less than 0.05 was considered statistically significant.

Results: The study incorporated 17,583,546 and 11,503,514 prescriptions from the pre-COVID-19 and COVID-19 periods, respectively. The utilization of antibacterials, as measured by DDD/1000 inhabitants per year, exhibited a significant decline from 298.36 to 202.10 DIY admissions following the onset of the COVID-19 pandemic. In the pre-COVID-19 era, Azithromycin and Cefixime were the most frequently used antibacterials, while Azithromycin was the predominant antibacterial during the COVID-19 period. Although Azithromycin usage experienced a slight decrease, Clarithromycin usage saw a statistically significant increase among the 44 dosage forms examined. Despite the overall Azithromycin usage remaining relatively stable, there was a noticeable shift in the preferred dosage forms: the 250 mg capsule form saw a decrease in usage during the pandemic, whereas the 500 mg capsule/tablet form saw an increase.

Conclusions: The study found a decrease in antibiotic use in Iran's outpatient setting during the COVID-19 pandemic, using data from an insurance organization. The research revealed variations in antibiotic usage across different categories and dosage forms. It recommends future studies to use broader databases that include both outpatient and inpatient settings to offer a more comprehensive understanding of antibiotic consumption patterns in Iran.