Use of Azithromycin Attributable to Acute SARS-CoV-2 Infection.

IF 2.4 4区医学 Q3 PHARMACOLOGY & PHARMACY Pharmacoepidemiology and Drug Safety Pub Date : 2024-07-01 DOI:10.1002/pds.5857

Carlo Gagliotti, Federico Banchelli, Rossella Buttazzi, Enrico Ricchizzi, Lorenzo Maria Canziani, Maurizia Rolli, Evelina Tacconelli, Maria Luisa Moro, Elena Berti

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Abstract

Purpose: In the early stages of the COVID-19 pandemic, preliminary results that later proved to be incorrect suggested the possible efficacy of anti-infective drugs such as azithromycin for the treatment of SARS-CoV-2 infection. These preliminary data may have influenced the prescription of azithromycin. However, no individual-level data linking the use of this antibiotic to acute SARS-CoV-2 infection are available. The present analysis aims to fill this gap.

Methods: A retrospective population-based cohort design was used including patients diagnosed with SARS-CoV-2 infection in the period ranging from February 2020 to February 2022. The data source for antibiotic consumption was the drug database of outpatient prescriptions of Emilia-Romagna Region (Italy). Antibiotics were classified according to the Anatomical Therapeutic Chemical (ATC) classification system. Consumption rates and percentages of azithromycin DDDs (defined daily doses) during the acute phase of the infection were compared with a previous control period and with the post-acute phase. Analyses were stratified by four groups according to the prevalent virus variant at time of diagnosis.

Results: Comparing the previous control period with the acute phase of infections, the rates of azithromycin consumption (DDD per 1000 individuals per day) increased from 1.17 to 23.11, from 0.80 to 33.03, from 0.81 to 21.01, and from 1.02 to 9.76, in the pre-Alpha, Alpha, Delta, and Omicron periods, respectively. Similarly, the percentages of individuals receiving azithromycin, and the azithromycin DDDs percentages over total systemic antibiotics DDDs increased in acute phases of infection compared with control periods. The consumption rates and percentages returned to preinfection levels in the post-acute phase. In the study period, 12.9% of the use of azithromycin in the entire adult population of Emilia-Romagna was attributable to acute SARS-CoV-2 infection.

Conclusions: Considering the low likelihood of bacterial coinfections, the increased azithromycin consumption in the acute phase of SARS-CoV-2 infection suggests inappropriate prescribing of this antibiotic.

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因急性 SARS-CoV-2 感染而使用阿奇霉素。

目的：在 COVID-19 大流行的早期阶段，一些后来被证明是错误的初步结果表明，阿奇霉素等抗感染药物对治疗 SARS-CoV-2 感染可能有效。这些初步数据可能影响了阿奇霉素的处方。然而，目前还没有将使用这种抗生素与急性 SARS-CoV-2 感染联系起来的个人层面的数据。本分析旨在填补这一空白：方法：采用基于人群的回顾性队列设计，包括 2020 年 2 月至 2022 年 2 月期间确诊感染 SARS-CoV-2 的患者。抗生素消耗量的数据来源是意大利艾米利亚-罗马涅大区门诊处方药物数据库。抗生素根据解剖治疗化学（ATC）分类系统进行分类。将感染急性期阿奇霉素 DDDs（规定日剂量）的消耗率和百分比与之前的对照期和急性期后进行了比较。根据确诊时流行的病毒变种，按四组进行了分层分析：结果：与之前的对照期和感染的急性期相比，阿奇霉素的消耗率（每天每千人的 DDD）在前阿尔法期、阿尔法期、德尔塔期和奥密克隆期分别从 1.17 增加到 23.11、从 0.80 增加到 33.03、从 0.81 增加到 21.01 以及从 1.02 增加到 9.76。同样，与对照组相比，在感染的急性期，接受阿奇霉素治疗的人数百分比和阿奇霉素剂量占全身抗生素总剂量的百分比都有所上升。在急性感染后阶段，服用率和百分比恢复到感染前的水平。在研究期间，艾米利亚-罗马涅整个成年人口中 12.9% 的阿奇霉素使用是由于急性 SARS-CoV-2 感染：考虑到细菌并发感染的可能性较低，SARS-CoV-2 感染急性期阿奇霉素用量的增加表明这种抗生素的处方不当。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pharmacoepidemiology and Drug Safety 医学-药学

CiteScore

4.80

自引率

7.70%

发文量

173

审稿时长

3 months

期刊介绍： The aim of Pharmacoepidemiology and Drug Safety is to provide an international forum for the communication and evaluation of data, methods and opinion in the discipline of pharmacoepidemiology. The Journal publishes peer-reviewed reports of original research, invited reviews and a variety of guest editorials and commentaries embracing scientific, medical, statistical, legal and economic aspects of pharmacoepidemiology and post-marketing surveillance of drug safety. Appropriate material in these categories may also be considered for publication as a Brief Report. Particular areas of interest include: design, analysis, results, and interpretation of studies looking at the benefit or safety of specific pharmaceuticals, biologics, or medical devices, including studies in pharmacovigilance, postmarketing surveillance, pharmacoeconomics, patient safety, molecular pharmacoepidemiology, or any other study within the broad field of pharmacoepidemiology; comparative effectiveness research relating to pharmaceuticals, biologics, and medical devices. Comparative effectiveness research is the generation and synthesis of evidence that compares the benefits and harms of alternative methods to prevent, diagnose, treat, and monitor a clinical condition, as these methods are truly used in the real world; methodologic contributions of relevance to pharmacoepidemiology, whether original contributions, reviews of existing methods, or tutorials for how to apply the methods of pharmacoepidemiology; assessments of harm versus benefit in drug therapy; patterns of drug utilization; relationships between pharmacoepidemiology and the formulation and interpretation of regulatory guidelines; evaluations of risk management plans and programmes relating to pharmaceuticals, biologics and medical devices.