Antibiotic Prescribing in COVID-19 Patients🦠💊| Closed-Loop Audit & Education #pencis #researchawards

Introduction

Antimicrobial resistance (AMR) represents a growing global public health challenge, driven largely by inappropriate and excessive antibiotic use. During the COVID-19 pandemic, uncertainty surrounding bacterial coinfections led to widespread empirical antibiotic prescribing, even though evidence consistently demonstrates a low prevalence of community-acquired bacterial coinfection (CABC) in patients presenting with COVID-19. This mismatch between actual infection rates and prescribing behavior has raised significant antimicrobial stewardship concerns. Understanding prescribing patterns and evaluating targeted interventions are therefore critical to minimizing unnecessary antibiotic exposure while maintaining patient safety.

Antibiotic Prescribing Patterns in COVID-19 Admissions

Despite accumulating evidence that CABC is uncommon, antibiotics continue to be prescribed to a notable proportion of hospitalized COVID-19 patients. This reflects clinical caution, overlapping symptoms between viral and bacterial infections, and diagnostic uncertainty at presentation. Evaluating real-world prescribing rates provides valuable insight into how evidence translates into practice and highlights opportunities to reduce avoidable antibiotic use without compromising clinical outcomes.

Rationale for Targeted Educational Interventions

Educational interventions tailored to local clinical workflows can be an effective antimicrobial stewardship strategy. By translating consensus recommendations into clear, practical criteria—such as leukocyte count, neutrophilia, and radiological findings—clinicians are supported in making evidence-based prescribing decisions. Locally developed education also encourages ownership and acceptance, increasing the likelihood of sustained behavior change.

Closed-Loop Audit as a Stewardship Tool

Closed-loop audits allow for systematic assessment of practice before and after an intervention, providing measurable outcomes for quality improvement. In the context of COVID-19, such audits are particularly valuable for monitoring antibiotic use trends, identifying deviations from guidelines, and assessing whether educational strategies lead to meaningful improvements in prescribing appropriateness.

Impact on Prescribing Appropriateness

While overall reductions in antibiotic prescribing rates may be modest, improvements in appropriateness are equally important. A higher proportion of prescriptions meeting predefined clinical criteria suggests better alignment with evidence-based practice. Even incremental improvements contribute to reduced selection pressure for resistant organisms and reinforce stewardship principles among frontline clinicians.

Implications for Antimicrobial Stewardship and Future Research

Findings from this research highlight that simple, targeted, and locally adaptable interventions can support antimicrobial stewardship, even in settings where baseline prescribing is relatively conservative. Future research should explore longer-term sustainability, integration of diagnostic stewardship tools, and expansion of similar interventions across diverse clinical settings to further combat antimicrobial resistance.

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