Antibiotic Prescribing Trends Among Iranian General Practitioners During COVID-19: Impacts on Antimicrobial Resistance

Background The COVID-19 pandemic disrupted global antibiotic prescribing practices, raising concerns about antimicrobial resistance (AMR). This study investigates trends in antibiotic use among Iranian general practitioners (GPs) across three distinct periods: pre-pandemic, pandemic, and post-pandemic. Methods A retrospective observational study was conducted using data from Iran’s National Hospital Information System (HIS). Antibiotic prescribing patterns were analyzed across three phases: pre-COVID (January 2019–May 2020), COVID (January 2020–May 2021), and post-COVID (June 2021–May 2022). Statistical analysis included descriptive statistics and trend comparisons. Prescribed antibiotics included oral agents (e.g., azithromycin, amoxicillin) and injectable agents (e.g., penicillin G). Results Antibiotic prescriptions increased by 87% during the pandemic compared to pre-COVID levels (107,365 vs. 200,433 items), primarily driven by azithromycin and β-lactams. Post-pandemic usage remained elevated (+ 94% vs. pre-COVID levels). Injectable penicillin prescriptions saw a sharp decline post-pandemic, while oral antibiotics dominated prescribing patterns. GP workloads fluctuated significantly, with prescriptions per GP rebounding post-pandemic (23,300 vs. 15,334 during COVID). Conclusions The COVID-19 pandemic entrenched reliance on broad-spectrum antibiotics, exacerbating AMR risks. Immediate interventions—such as antimicrobial stewardship programs, GP education, and rapid diagnostic tools—are essential to mitigate overprescribing and safeguard public health. Trial Registration Not applicable; this study did not involve interventional trials on human participants.