Background and importance The characteristics of the patient who requires health care are different between primary care (PC) and hospital care (HC). The COVID-19 pandemic has impacted on public access to health services. Therefore, prescribing patterns and consumption of antimicrobials in both contexts could have changed.

Aim and objectives To assess the impact of the COVID-19 pandemic on antimicrobial consumption in PC and HC.

Material and methods Descriptive cross-sectional study that evaluated the antimicrobial consumption (ATC J01) in adult patients 1 year before (March 2019–February 2020) and 1 year after (March 2020–February 2021) the arrival of the COVID-19 pandemic.

Antimicrobial consumption rates were expressed in defined daily doses per 1000 inhabitants-day (DID). In PC we included the reference population of our area and in HC the number of patients discharged. The impact was assessed by the difference in DID between both periods and care settings.

Data on antimicrobial prescribing in PC were obtained from a public database with anonymised data on the total number of items of each drug prescribed. Hospital data were obtained from the clinical unit of pharmacy.

Results Between March 2020 and February 2021 antimicrobial consumption decreased –36.0% (7.3 vs 11.4 DID) in PC and increased +37.5 (16.5 vs 12.0 DID) in HC, both compared to the same period of the previous year.

The most prescribed antimicrobials in PC before the COVID-19 pandemic were amoxicillin, amoxicillin/clavulanate, doxycycline, azithromycin, ciprofloxacin, and between March 2020 and February 2021 these were amoxicillin/clavulanate, amoxicillin, doxycycline, ciprofloxacin and azithromycin.

The most prescribed antimicrobial used in HC before the COVID-19 pandemic were amoxicillin/clavulanate, levofloxacin, piperacillin/tazobactam, ceftriaxone and ciprofloxacin, and between March 2020 and February 2021 these were amoxicillin/clavulanate, ceftriaxone, azithromycin, piperacillin/tazobactam and meropenem.

Comparing the COVID period with the previous year, in PC the antimicrobial that most decreased in consumption was phenoxymethylpenicillin (–66.59%). Amoxicillin decreased by –52.13%, clarithromycin (–50.60%), moxifloxacin (–45.98%), levofloxacin (–44.42%), amoxicillin/clavulanate (–35.55%) and azithromycin (–29.05%). For HC the antimicrobial that most increased in consumption was azithromycin (+721.42%), followed by amoxicillin (+602.0%), ceftriaxone (+184.34%), vancomycin (+116.9%) and amikacin (+88.79%). Meropenem DID increased by +52.94%.

Conclusion and relevance The COVID-19 pandemic has impacted on the increase in antimicrobial use in HC along with a proportional decrease in PC.

Antimicrobial prescription patterns in PC remain stable. The increase in amoxicillin/clavulanate over amoxicillin may be related to non-contact patient care (telemedicine).

In HC, antimicrobial stewardship strategies can help return the consumption of broad-spectrum antibiotics to acceptable levels.

Conflict of interest No conflict of interest