Azithromycin consumption during the COVID-19 pandemic in Croatia, 2020

  1. Nikolina Bogdanić
  2. Loris Močibob
  3. Toni Vidović
  4. Ana Soldo
  5. Josip Begovać

Reviewed by

Read the full article

Listed in

Log in to save this article

Abstract

During the initial phase of the COVID-19 pandemic, there was great enthusiasm for the use of azithromycin with or without hydroxychloroquine.

Objectives

We analyzed azithromycin consumption in Croatia in 2020 and compared this to the period 2017–2019.

Methods

Azithromycin consumption was evaluated using the IQVIA Adriatic d.o.o. database which collects data on azithromycin distribution from wholesale pharmacies to hospital and non-hospital pharmacies in Croatia. We analyzed data for the period from January 2017 to December 2020. Azithromycin distribution was measured as days of therapy (DOT) and reported as per 1000 inhabitants or per 1000 inhabitant-days.

Results

In the period 2017–2020, total azithromycin DOT in Croatia increased in 2017, 2018, 2019, and 2020 (1.76, 1.91, 1.91 and 2.01/1000 inhabitant-days, respectively). Non-hospital pharmacies received 2.18 times and hospital pharmacies 4.39 times more DOT units/1000 inhabitants of azithromycin in March 2020 compared to the average distribution rate in March 2017–2019. During the peak of the COVID-19 epidemic (November and December 2020) azithromycin distribution increased considerably in hospital (3.62 and 3.19 times, respectively) and non-hospital pharmacies (1.93 and 1.84 times, respectively) compared to the average consumption in the same months in 2017–2019.

Conclusions

Our data showed increased azithromycin distribution in the period 2017–2020 which indicates azithromycin overuse. Preliminary information on COVID-19 treatments with a desire to offer and try what is available even in the absence of strong scientific evidence may have influenced practices of antimicrobial prescriptions.

Article activity feed

  1. Version published to 10.1371/journal.pone.0263437
  2. ScreenIT

    SciScore for 10.1101/2021.10.31.21265714: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsIRB: The study was approved by the Ethical Committee of the University Hospital for Infectious Diseases, Zagreb, Croatia.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Our study has limitations. The data on individual patients were not available and we could not follow up dispensed azithromycin from pharmacies to patients. However, it is quite certain that all quantities of distributed azithromycin have been dispensed to patients. We were also not able to report more standard measures of antibiotic usage such as defined daily dose or DOT per 1000 patient-days. Nevertheless, we did provide data on azithromycin overuse during the COVID-19 epidemic in Croatia. Even though an increase of 8.1% of total azithromycin DOT from the average of 2017– 2019 compared to 2020 seems modest, we should highlight the fact that Croatia is already one of the countries with highest percentage of macrolide resistant isolates among EU/EEA countries [20]. Macrolides were the second most common used antibiotics with azithromycin accounting for most of the use in Croatia in 2014 – 2019 with daily defined doses (DDD)/1000 inhabitants per day of 2.58, 2.82, 2.55, 2.56, 2.73, 2.72, respectively, after penicillins including beta-lactamase inhibitors [21,22]. Sample of Streptococcus pneumoniae with estimated national population coverage of 80% showed increasing trend in macrolides resistance in the period 2015 – 2018 (19, 34, 36, 32%, respectively) [20]. Resistance data collected from 38 centers in Croatia in 2019 showed 31% resistant S. pneumoniae to macrolides with a range of local results from 0 to 53% and 9% of macrolide resistant Streptococcus pyogenes with a range o...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2021.10.31.21265714v1 on medRxiv