Impact of COVID-19 containment measures on antibiotic prescribing for respiratory and ear diseases in pediatric primary care

BACKGROUND: In Italy, the antibiotic prescription rate for children is very high. The aim of this study is to evaluate the change in the monthly rate of antibiotic prescriptions for respiratory and ear infections among children during the COVID-19 pandemic. METHODS: This retrospective study included all children aged <14 years who referred to a pediatric primary care clinic in Milan (Italy) between January 1, 2019, and April 30, 2022. We examined the trends in the antibiotic prescription rate, comparing the pre-lockdown (2019), total lockdown (March-April 2020), partial lockdown (November-December 2020) and post-lockdown (November-December 2021 and March-April 2022) periods. RESULTS: A total of 12 569 visits (mean age of patients: 6.3±3.8 years), with 3228 antibiotic prescriptions, were included in the study. The overall antibiotic prescription rate was 25.7%, with a nadir (5.8%) in May 2020. Compared to 2019, the highest reduction in antibiotic prescription rate was found in February 2021 (−30.3% [95% CI, -36.2%, -24.4%]). A significant increase in the antibiotic prescription rate was observed in November-December 2021 and in March-April 2022 compared to the corresponding periods of the previous year (P<0.001). CONCLUSIONS: This study showed a drastic decrease in the antibiotic prescription rate for respiratory and ear infections during the COVID-19 pandemic, with a nadir immediately after the total lockdown. Day care center and school attendance did not reverse this positive trend during the partial lockdown, unlike what happened with the relaxation of restrictive measures and the resumption of social activities after the lockdown.