Post-pandemic consumption of outpatient antibiotics in Switzerland up to pre-pandemic levels, 2018–2023: An interrupted time series analysis

Background:The COVID-19 pandemic has been a challenge for health-care systems and antibiotic stewards as uncertainty regarding treatment and bacterial coinfections raised concern.Methods: This retrospective observational study examined the association of the pandemic on outpatient antibiotic sales and prescriptions in Switzerland using interrupted time series (ITS) analyses.Data from IQVIA and the Sentinella Network were used to analyze antibiotic consumption and prescription patterns over a 72-month period from January 2018 to December 2023, divided into pre-pandemic, pandemic, and post-pandemic periods.Results: Antibiotic consumption decreased during the pandemic and returned to pre-pandemic levels in the postpandemic period.A decrease in level was most pronounced in the French-speaking region (-2.82 defined daily doses per 1,000 inhabitants per day (DID) per month, 95 %CI [-4.34, -1.30], p < 0.001) and the Italianspeaking region (-2.80 DID per month, 95 %CI [-4.78, -0.82], p < 0.01), followed by the German-speaking region (-1.72 DID per month, 95 %CI [-2.71, -0.74], p < 0.01).Similarly, in the ITS, the relative change of model estimates in antibiotic prescriptions by GPs and pediatricians for upper respiratory tract infections, was of -36.0 % and -50.3 % resp. in the pandemic period and +10.1 % and -2.6 % in the post-pandemic period compared with the pre-pandemic period.Conclusions: A decrease of antibiotic prescriptions was observed in GPs and pediatricians during the COVID-19 pandemic, followed by a return to pre-pandemic levels.The patterns in antibiotic prescriptions aligned with the epidemiology of respiratory infections and demonstrated a pronounced association with the implementation and subsequent removal of non-pharmaceutical interventions.