Evaluation of Hospital Antibiotic Consumption during the COVID-19 Pandemic

Introduction: Antimicrobial resistance (AMR) is a pressing global health issue exacerbated
by the overuse of antibiotics during the COVID-19 pandemic. Despite WHO guidelines
against antibiotics for mild-to-moderate COVID-19 cases without bacterial co-infection, significant
misuse has been reported globally. This study aimed to evaluate antibiotic consumption during
the COVID-19 pandemic at a hospital in North Macedonia and to analyze adherence to WHO
guidelines, with a focus on antimicrobial stewardship, using the ATC and WHO AWaRe classification
systems. To analyze antibiotic utilization trends from January 2020 to December 2021
and assess adherence to WHO guidelines, focusing on the potential impact on AMR.
Methods: This retrospective observational study measured antibiotic consumption in defined daily
doses (DDD) per 100 occupied bed-days (DDD/100 OBD) using ATC and WHO AWaRe
classifications. Data were obtained only from ICU inpatients treated at the Clinical Hospital in
Shtip, North Macedonia. Trends in annual consumption were analyzed, including rate-of-change
calculations for individual antibiotics between 2020 and 2021.
Results: Total antibiotic consumption decreased from 2902.6 DDD/100 OBD in 2020 to 2286.5
DDD/100 OBD in 2021. A third-generation cephalosporin, ceftriaxone, was the most consumed
antibiotic, accounting for 57.62% of total consumption in 2020 and 48.55% in 2021. Tetracycline
use slightly increased from 13.88% in 2020 to 15.83% in 2021. Fluoroquinolone use decreased
significantly from 15.22% in 2020 to 6.5% in 2021. Carbapenem consumption rose sharply from
1.7% in 2020 to 14.37% in 2021, while azithromycin use declined threefold. Antibiotics in the
Access group accounted for less than 20% of total usage, while those in the Watch group predominated.
Discussion: The study highlights a continued reliance on broad-spectrum antibiotics during the
pandemic, diverging from WHO recommendations emphasizing Access to antibiotics. These
trends suggest inadequate implementation of antimicrobial stewardship practices and raise concerns
about their long-term impact on AMR. Limitations include the retrospective, single-center
design, which may limit the generalizability of the findings.
Conclusion: The findings underscore the high dependency on Watch category antibiotics and a
limited focus on Access antibiotics, contrary to WHO recommendations. This highlights the urgent
need for robust antimicrobial stewardship programs to control inappropriate antibiotic use
and combat AMR.