Azithromycin use before and during the COVID- 19 pandemic and the impact of implementing national evidence-based guidelines in Qatar

Background

Initial small, uncontrolled studies suggested a beneficial effect of azithromycin in individuals with COVID-19. However, subsequent studies have not confirmed its effectiveness. We assessed azithromycin usage before and during the pandemic in a national healthcare system in Qatar and the impact of implementation of evidence-based guidelines upon prescription rates.

Methods

Using electronic medical records, we retrieved all azithromycin prescriptions from 2019 to 2022 at the public healthcare system in Qatar which provides over 85 % of healthcare in Qatar. Azithromycin prescription numbers and rates/100,000 population were calculated and compared over time. A course was defined as any azithromycin prescription for ≥5 days with no gap of >10 days. Courses were considered COVID-19-related if prescribed −3 to +10 days post positive SARS-CoV-2 PCR. Prescription rates before and after the pandemic, and before and after evidence-based guidelines implementation (in June 2020) were compared.

Results

During the study period, 203,806 azithromycin courses were prescribed to 166,062 individuals. Overall number of courses increased in the first 2 quarters of 2020 (average 12,857/quarter in 2019 to average of 19,297 in Q1-Q2 of 2020) and then dropped to 9881/quarter over the next 6 quarters. COVID-19 related azithromycin courses peaked in.

2020-Q2 (13,691) and dropped to 2836 for 2020-Q3, 1410 for 2020-Q4; 5465 for 2021-Q1, and 4288 for 2021-Q2. Stringent COVID-19 guidelines in June 2020 rapidly reduced azithromycin usage.

Conclusions

Azithromycin prescriptions increased immediately after the COVID-19 pandemic, but rapidly declined immediately after implementing evidence-based guidelines.