The quantitative evaluation of antibiotic utilization in community health centers during the COVID-19 pandemic: a cross-sectional multicenter study

Abstract

Introduction: Uncertainty and rapid changes in treatment guidelines are influencing factors for medication use during the COVID-19 pandemic. Therefore, this study aimed to evaluate antibiotic utilization in Community Health Centers (CHCs) between 2020 and 2021.

Methodology: Prescription data from adult outpatient visits (≥ 18 years) receiving prescription services at 35 CHCs in South Jakarta, Malang regency, and Bengkulu city, comprising 796,598 prescriptions, were examined using the ATC/DDD methodology and DU90% analysis. These regions were purposively selected to represent three distinct healthcare archetypes, namely metropolitan (South Jakarta), rural-urban continuum (Malang Regency), and regional cities outside Java (Bengkulu City). Wilcoxon signed-rank and Chi-square tests were used to determine statistical differences between years.

Results: The proportion of adult patient visits receiving a minimum of one antibiotic prescription decreased by 1.56% in 2021 (p < 0.001). Malang Regency recorded the highest rates, decreasing by 2.24% in 2021. Furthermore, the highest DDD values for all antibiotics each year were recorded in South Jakarta, except for Cefadroxil, which peaked in Malang regency. Six antibiotics were constituted in the DU90% segment, with Amoxicillin accounting for over 50% of prescriptions and reaching 425 DDD/1000 patient visits/year in South Jakarta in 2020. In 2021, Azithromycin prescriptions increased significantly by 7.51%, as shown by a p of 0.0161. The average prescribing rate (14.57%) remained below the WHO optimal indicator (< 30%).

Conclusions: Antibiotic use in CHCs declined during the pandemic, but there was a significant increase in Azithromycin prescriptions.