Trends in Prescribing of Antibiotics and Drugs Investigated for Coronavirus Disease 2019 (COVID-19) Treatment in US Nursing Home Residents During the COVID-19 Pandemic

• Published in: Clinical infectious diseases Vol. 74; no. 1; pp. 74 - 82
• Main Authors: Gouin, Katryna A, Creasy, Stephen, Beckerson, Mary, Wdowicki, Martha, Hicks, Lauri A, Lind, Jennifer N, Geller, Andrew I, Budnitz, Daniel S, Kabbani, Sarah
• Format: Journal Article
• Language: English
• Published: US Oxford University Press 07-01-2022
• Subjects: Anti-Bacterial Agents - therapeutic use; COVID-19 - drug therapy; Humans; Nursing Homes; Pandemics; Pharmaceutical Preparations; SARS-CoV-2; COVID-19; adverse drug events; nursing home; antibiotic stewardship
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1093/cid/ciab225

Abstract
Background
Trends in prescribing for nursing home (NH) residents, which may have been influenced by the coronavirus disease 2019 (COVID-19) pandemic, have not been characterized.
Methods
Long-term care pharmacy data from 1944 US NHs were used to evaluate trends in prescribing of antibiotics and drugs that were investigated for COVID-19 treatment, including hydroxychloroquine, famotidine, and dexamethasone. To account for seasonal variability in antibiotic prescribing and decreased NH occupancy during the pandemic, monthly prevalence of residents with a prescription dispensed per 1000 residents serviced was calculated from January to October and compared as relative percent change from 2019 to 2020.
Results
In April 2020, prescribing was significantly higher in NHs for drugs investigated for COVID-19 treatment than 2019; including hydroxychloroquine (+563%, 95% confidence interval [CI]: 5.87, 7.48) and azithromycin (+150%, 95% CI: 2.37, 2.63). Ceftriaxone prescribing also increased (+43%, 95% CI: 1.34, 1.54). Prescribing of dexamethasone was 36% lower in April (95% CI: .55, .73) and 303% higher in July (95% CI: 3.66, 4.45). Although azithromycin and ceftriaxone prescribing increased, total antibiotic prescribing among residents was lower from May (−5%, 95% CI: .94, .97) through October (−4%, 95% CI: .94, .97) in 2020 compared to 2019.
Conclusions
During the pandemic, large numbers of residents were prescribed drugs investigated for COVID-19 treatment, and an increase in prescribing of antibiotics commonly used for respiratory infections was observed. Prescribing of these drugs may increase the risk of adverse events, without providing clear benefits. Surveillance of NH prescribing practices is critical to evaluate concordance with guideline-recommended therapy and improve resident safety.
During the coronavirus disease 2019 (COVID-19) pandemic, there was a higher prevalence of nursing home residents with a prescription dispensed for drugs that were investigated for COVID-19 treatment and antibiotics commonly used for respiratory infections than in the previous year.