LAUSR

Objective This study investigated the association between the COVID-19 pandemic and antibiotic prescription ratios and its determinants 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 over 33 million community medical encounters per year. In the COVID-19 period, 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 (ID) etiology decreased by 10% and prescriptions per visit decreased by 39% (from 1,034,425 prescriptions/3,764,235 ID visits, to 587,379/3,426,451 respectively). This decrease was observed in both sexes and all age groups. Telemedicine visits were characterized by 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 odds ratio of 0.852 (95%CI 0.848, 0.857). Conclusion 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, in the transfer to telemedicine, and to a change in prescription practices among community-based physicians.