Article Figures & Data
Figures
- Figure 1.
Monthly Number of Defined Daily Doses for Antibiotics in France January 2010 Through March 2022
Note: Selected antiobiotics include amoxicillins, drugs with indication for urinary tract infections (reds), macrolides (greens), and phenoxymethylpenicillin (for chronic conditions).
Tables
- Table 1.
Change in Use of Specific Antibiotics Due to the COVID-19 Pandemic 3 and 12 Months After First Lockdown in France
Pre-pandemic DDDs Change in DDDs observed vs expected at 3 months Change in DDDs observed vs expected at 12 months Antibiotic class and name No. 95% CI % 95% CI % 95% CI Penicillins Amoxicillin 2,914 2,372 to 3,455 −27.5 −35.1 to −17.9 −55.5 −71.8 to −39.2 Amoxicillin-clavulanic acid 147 −125 to 420 −10.9 −19.5 to −0.3 −24.9 −32.2 to −17.6 Cloxacillin −91 −104 to −78 −6.6 −27.5 to 31.4 −6.3 −17.0 to 4.4 Oxacillin −57 −70 to −44 −41.6 −94.1 to 10.9 16.5 −68.1 to 84.6 Benzylpenicillin −1 −2 to −1 −13.8a −22.8 to −4.9 5.5a −3.9 to 14.9 Phenoxymethylpenicillin 65 58 to 72 26.1 2.5 to 49.7 11.8 −2.5 to 26.1 Piperacillin 1 1 to 1 −15.9 −39.6 to 7.8 −11.8 −35.3 to 11.7 Pivmecillinam 188 175 to 200 −10.2 −14.4 to −5.6 −105.5 −136.5 to −74.5 Cephalosporins Cefuroxime −151 −194 to −107 −15.6 −40.8 to 10.7 −32.0 −41.4 to −22.6 Cefaclor −37 −43 to −30 −6.2 −21.7 to 9.2 −14.4 −18.6 to −10.2 Cefpodoxime −280 −367 to −193 −16.6 −42.4 to 9.2 −25.6 −33.1 to −18.1 Cefixime 16 −18 to 51 −7.8 −24.3 to 8.7 −6.8 −14.7 to −1.1 Ceftriaxone 10 2 to 18 −2.7 −10.3 to 4.9 −27.5 −35.6 to −19.4 Cefepime 1 1 to 1 −22.0 −40.4 to 3.6 −8.3 −10.7 to −5.9 Ceftazidime 2 1 to 2 −17.0 −28.8 to −6.6 −6.9 −21.2 to 7.4 Cefadroxil −14 −16 to −12 −23.9 −63.7 to 15.9 −3.1 −15.6 to −12.1 Tetracyclines Doxycycline 67 −105 to 239 −21.7 −43.0 to 0.4 −3.5 −17.5 to 10.5 Minocycline −47 −54 to −40 −6.1 −25.9 to 13.7 −0.3 −2.4 to 1.8 Tetracycline 20 −4 to 44 −12.4 −29.5 to 4.7 5.4 −11.6 to 22.4 Macrolides Azithromycin 276 236 to 315 −6.3 −24.7 to 12.1 2.7 0.1 to 5.3 Clarithromycin −347 −425 to −270 −9.8 −29.6 to 10.0 −26.9 −34.8 to −19.0 Erythromycin −19 −22 to −16 −13.1 −25.5 to 0.8 −3.3 −17.2 to 10.6 Josamycin −104 −133 to −75 −22.2 −45.6 to 1.2 −39.0 −50.5 to −27.5 Roxithromycin −55 −91 to −18 −17.7 −32.7 to −2.7 −44.7 −67.8 to −21.6 Spiramycin −3 −11 to 5 −7.1 −16.7 to 2.5 −34.4 −44.5 to −24.3 Spiramycin in combinations −78 −89 to −66 −16.1 −29.3 to −2.7 −5.8 −19.0 to 7.4 Fluoroquinolones Ciprofloxacin −25 −40 to −9 −4.5 −10.9 to 2.9 −2.6 −9.8 to 4.6 Levofloxacin −15 −36 to 6 −6.2 −18.9 to 6.0 −23.6 −30.5 to −16.7 Moxifloxacin −70 −79 to −61 −7.3 −23.1 to 8.5 −2.0 −7.4 to 3.4 Ofloxacin 37 17 to 57 −3.9 −12.1 to 5.8 −3.4 −18.1 to 14.7 Other antibiotics Tobramycin 3 0 to 5 −5.3 −12.7 to 2.1 −5.3 −12.7 to 2.1 Clindamycin 44 42 to 46 −5.6 −11.2 to 0.0 −7.7 −10.0 to −5.4 Sulfadiazine −4 −4 to −3 −41.9 −52.3 to −25.9 −8.7 −21.3 to 3.9 Sulfamethoxazole-trimethoprim 29 24 to 35 8.4 −1.8 to 18.6 −5.5 −17.1 to 6.1 Trimethoprim 2 2 to 3 −0.2 −4.8 to 4.4 79.6 56.2 to 103.0 Pristinamycin −41 −104 to 21 −15.9 −24.1 to −7.6 −29.1 −47.7 to −10.5 Fosfomycin 70 66 to 73 −10.4 −13.9 to −6.8 −8.6 −16.1 to −1.1 Colistin 1 1 to 2 8.1 1.5 to 14.7 −2.1 −9.2 to 5.0 Nitrofurantoin −60 −70 to −51 −185.1 −246.5 to −123.7 −21.3 −55.6 to 13.0 DDDs = delivered daily doses.
Note: Prior trend is the overall evolution of the monthly number of reimbursed DDDs for each antibiotic in France from January 2010 to near the start of first lockdown in March 2020 (roughly 10 years of data). Values in bold are significant at the level of α = .05
↵a Estimated since June 2018.
SUPPLEMENTAL MATERIALS IN PDF FILE BELOW
Supplemental Appendix. ARIMA Models
Supplemental Table 1. Impact of the COVID pandemic and associated containment measures on monthly defined daily doses (DDDs) reimbursement for antibiotics in France: estimation of the effect over the 3-month period following the first French national lockdown start (March 2020)
Supplemental Table 2. Impact of the COVID pandemic and associated containment measures on monthly defined daily doses (DDDs) reimbursement for antibiotics in France: estimation of the effect over the 12-month period following the first French national lockdown start (March 2020)
Supplemental Table 3. Impact of the COVID pandemic and associated containment measures on monthly defined daily doses (DDDs) reimbursement for antibiotics in France: estimation of the effect over the 24-month period following the first French national lockdown start (March 2020)- Rousselot_Supp_App_Tables_1-3.pdf -
PDF file
- Rousselot_Supp_App_Tables_1-3.pdf -
PLAIN-LANGUAGE SUMMARY
Research Brief
Significant and Prolonged Decline in Ambulatory Antibiotic Use in France During COVID-19
Background and Goal: Before the COVID-19 pandemic, France had one of the highest antibiotic consumption rates in Europe. The pandemic and lockdown measures affected health care access and prescribing patterns, leading to significant changes in outpatient (ambulatory) antibiotic use. This study examined how systemic antibiotic use in France changed from 2020 to 2022 compared to expected trends.
Study Approach: Researchers used nationwide health insurance data covering 67 million people to track monthly antibiotic prescriptions from January 2010 to March 2022. They applied interrupted time-series analysis to measure changes in antibiotic use following the first national lockdown on March 17, 2020, while adjusting for seasonal trends and pre-existing usage patterns.
Main Results:
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Use of most antibiotics significantly decreased after the first lockdown and remained lower for at least 12 months compared to expected levels.
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Amoxicillin (−27.5% at 3 months; −55.5% at 12 months)
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Amoxicillin-clavulanic acid (−10.9% at 3 months; −24.9% at 12 months)
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Cefepime (−22% at 3 months; −8.3% at 12 months)
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Fosfomycin (−10.4% at 3 months; −8.6% at 12 months)
Some antibiotics (e.g., colistin, phenoxymethylpenicillin, trimethoprim-sulfamethoxazole) with chronic indications temporarily increased
Azithromycin was an exception: Unlike other macrolides, its use did not decrease after the first lockdown (−6.3% at 3 months, which was not statistically significant) and actually increased over 12 months (+2.7%)
Why It Matters: The pandemic significantly reduced antibiotic use, particularly for those with indications for the treatment of respiratory and urinary tract infections, which may indicate that some antibiotics were overprescribed before COVID-19. The findings from this study emphasize the need for continued antimicrobial stewardship efforts and clear public health messaging during health crises.
Changes in the Ambulatory Use of Antibiotics in France Due to the COVID-19 Pandemic in 2020- 2022: A Nationwide Time-Series Analysis
Nicolas Rousselot, MD, MSc, et al
Department of General Practice, University of Bordeaux, Bordeaux, France
Inserm U1219, Bordeaux Population Health Research Center, Bordeaux, France
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