Pittsburgh—Even though COVID-19 is caused by a virus, past research indicated that nearly one-third of Medicare patients who had an outpatient visit received a prescription for an antibiotic.

That led University of Pittsburgh School of Medicine researchers to investigate antibiotic receipt at COVID-19-related visits for commercially insured patients aged up to 64 years. To do that, the study team identified outpatient visits with an ICD-10 diagnosis code of U07.1 between April 1, 2020, and May 31, 2022, in the OptumLabs Data Warehouse, which contains deidentified claims from 10% to 20% of commercially insured individuals in the United States.

“Consistent with prior research, we identified outpatient visits by individuals with both medical and pharmacy coverage and their association with antibiotic fills within 7 days before or after these visits,” the researchers reported in the Journal of the American Medical Association Health Forum. “We limited analysis to COVID-19-related visits and excluded 5% of these visits (and associated antibiotics) with a co-diagnosis for which antibiotics may be appropriate. We classified all remaining visits as in-person physician office, practice-based telemedicine, direct-to-consumer telemedicine, emergency department (ED), urgent care, or other.”

For the study, more than 1.2 million adult visits and more than 177,000 were analyzed. The results indicated that receipt of antibiotic prescriptions during COVID-19-related visits increased with age: 4% in the 0-to-5-year to 16% in the 45-to-64-year age group. The researchers added that COVID-19-related visits made up 20% of acute respiratory tract infection (ARTI)–related visits and 7% of ARTI-related antibiotic receipt among all groups during the time period.

“In sensitivity analyses of antibiotic fills within 2 (vs. 7) days of visits, antibiotic receipt was 4% vs 5% in children and adolescents and 11% vs 13% in adults,” the authors wrote. “COVID-19-related visits in children and adolescents vs. adults occurred predominantly in physician offices (66% vs. 51%), followed by EDs (12% vs. 18%) and practice-based telemedicine (11% vs. 17%).”

The receipt of antibiotics varied by the site of care, but the highest rates overall were at practice-based telemedicine and emergency departments, except for patients aged 0 to 5 years. In that cohort, antibiotic receipt was highest during direct-to-consumer telemedicine visits.

In terms of region, antibiotic receipt was highest in the South (15%), followed by the West (9%), Midwest (9%), and Northeast (7%).

For the youngest patients, children aged younger than 6 years, the most common antibiotic was amoxicillin (37%) followed by azithromycin (36%). For children and adolescents aged 6 years and older, as well as adults, azithromycin (68% and 70%) was more commonly prescribed than amoxicillin (15% and 4%).

Overall, the authors point out, antibiotic receipt at COVID-19-related visits was much more an issue for adults than children and adolescents and varied markedly by region and site of care. “Increased prescriptions in adults may be associated with a higher prevalence of comorbidities and higher risks of adverse outcomes,” they explained.

The findings of antibiotic receipt being highest at EDs and practice-based telemedicine visits and of azithromycin being the most commonly prescribed were consistent with prior results. “Azithromycin might be selected for its potential anti-inflammatory and antiviral properties, especially before more data were available,” the researchers stated. “Amoxicillin use among the youngest group suggests concerns about associated (but undiagnosed) bacterial infection such as otitis media or pneumonia.”

The authors cautioned that their study did not examine how the severity of illness or presence of comorbidities was associated with antibiotic use. “Understanding these prescribing practices will inform efforts to improve antibiotic stewardship,” they added.

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