Ambulatory antibiotic use in France showed significant decline during the COVID-19 pandemic

Research Brief

Background and Goal: The COVID-19 pandemic and lockdown measures in France affected health care access and prescribing patterns, leading to significant changes in outpatient (ambulatory) antibiotic use. This study examined how systemic antibiotic use in France changed from 2020 to 2022 compared to expected trends.

Study Approach: Researchers used nationwide health insurance data covering 67 million people to track monthly antibiotic prescriptions from January 2010 to March 2022. They applied interrupted time-series analysis to measure changes in antibiotic use following the first national lockdown on March 17, 2020. Main Results:

• Use of most antibiotics significantly decreased after the first lockdown and remained lower for at least 12 months compared with expected levels.

  • Amoxicillin (−27.5% at 3 months; −55.5% at 12 months)

  • Amoxicillin-clavulanic acid (−10.9% at 3 months; −24.9% at 12 months)

  • Cefepime (−22% at 3 months; −8.3% at 12 months)

  • Fosfomycin (−10.4% at 3 months; −8.6% at 12 months)

• Some antibiotics (e.g., colistin, phenoxymethylpenicillin, trimethoprim-sulfamethoxazole) with chronic indications temporarily increased

• Azithromycin use did not decrease after the first lockdown (−6.3% at 3 months, which was not statistically significant) and actually increased over 12 months (+2.7%)

Why It Matters: The pandemic significantly reduced antibiotic use, particularly for those with indications for the treatment of respiratory and urinary tract infections, which may indicate that some antibiotics were overprescribed before COVID-19. 

Changes in the Ambulatory Use of Antibiotics in France Due to the COVID-19 Pandemic in 2020- 2022: A Nationwide Time-Series Analysis 

Nicolas Rousselot, MD, MSc, et al

Department of General Practice, University of Bordeaux, Bordeaux, France

Inserm U1219, Bordeaux Population Health Research Center, Bordeaux, France

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