Figure 1
The PRISMA flow diagram of study selection
Table 1
Patterns of disproportionate antibiotic use during the COVID-19 pandemic
| Antibiotic class | Common agents reported | Route | Duration-related problem | Type of misuse/AMS concern | Ref. |
|---|---|---|---|---|---|
| Cephalosporins | Ceftriaxone and third-generation cephalosporins | IV | Treatment >7 days despite negative cultures, IV therapy >48 h without microbiological confirmation | Empirical treatment despite low bacterial co-infection rates, increased CDI risk, frequent use in ceftriaxone-azithromycin regimens | 12, 25, 28 |
| Macrolides | Azithromycin | PO/IV | Empirical use often continued despite lack of proven benefit | Presumed antiviral effect, unnecessary use and AMR selection pressure | 23, 25 |
| Carbapenems | Meropenem | IV | Broad-spectrum escalation during hospitalisation | Selection of MDR Gram-negative organisms, need for AMS restriction policies | 17 |
| Fluoroquinolones | Levofloxacin; moxifloxacin | PO/IV | Prolonged use despite negative microbiological findings | CDI risk, AMR selection pressure and unnecessary broad-spectrum coverage | 12, 17, 28 |
| Penicillins | Amoxicillin; ampicillin | PO/IV | Empirical prescribing without microbiological confirmation | Use for viral respiratory illness and low-probability bacterial infection | 17, 19 |
| β-lactam/β-lactamase inhibitor combinations | Piperacillin/tazobactam | IV | Increased use and escalation to broad-spectrum therapy | Selection pressure for MDR Gram-negative bacteria, need for reassessment and de-escalation | 17, 19, 21 |
| Aminopenicillin/β-lactamase inhibitor combinations | Amoxicillin/clavulanate | PO/IV | Continued use despite low likelihood of bacterial co-infection | Empirical respiratory infection treatment without confirmed bacterial infection | 17 |
Table 2
Impact of COVID-19 vaccination on antibiotic prescribing patterns
| Population | Main outcome | Effect of COVID-19 vaccination on antibiotic use | Ref. |
|---|---|---|---|
| Older adults receiving COVID-19 vaccination | Antibiotic prescribing after vaccination | COVID-19 vaccination was associated with significantly reduced antibiotic prescribing, particularly for respiratory infections (OR 0.961; 95 % CI 0.953–0.968) | 34 |
| 134,022 COVID-19 patients from 8 studies | Antibiotic use among COVID-19 patients | COVID-19 vaccination was associated with a 34 % reduction in the odds of antibiotic use (OR 0.662; 95 % CI 0.540–0.811) | 35 |