The COVID-19 Pandemic Enhanced the Decade-Long Trend of the Decreasing Utilization of Antibiotics.

PURPOSE/INTRODUCTION: A decline in antibiotic (AB) prescriptions was reported during the coronavirus 2019 (COVID-19) pandemic. Therefore, we investigated AB utilization during the COVID-19 pandemic using data from a large database in Germany. METHODS: AB prescriptions in the Disease Analyzer database (IQVIA) were analyzed for each year between 2011 and 2021. Descriptive statistics were used to assess developments in relation to age group, sex, and antibacterial substances. Infection incidence rates were also investigated. RESULTS: In total, 1,165,642 patients received antibiotic prescriptions during the entire study period (mean age: 51.8; SD: 18.4 years; 55.3% females). AB prescriptions started to decline in 2015 (505 patients per practice), and this development persisted until 2021 (2020: 300 patients per practice and 2021: 266 patients per practice). The sharpest drop was observed in 2020 and occurred in both women and men (27.4% and 30.1%). In the youngest age group (≤30), the decrease was -56%, while in the age group >70, it was -38%. The number of patients with prescriptions for fluoroquinolones dropped the most, falling from 117 in 2015 to 35 in 2021 (-70%), followed by macrolides (-56%) and tetracyclines (-56%). In 2021, 46% fewer patients were diagnosed with acute lower respiratory infections, 19% fewer with chronic lower respiratory diseases, and just 10% fewer with diseases of the urinary system. CONCLUSION: AB prescriptions decreased more in the first year (2020) of the COVID-19 pandemic than infectious diseases did. While the factor of older age influenced this trend negatively, it remained unaffected by the factor of sex and the selected antibacterial substance.

Obesity and lipid metabolism disorders determine the risk for development of long COVID syndrome: a cross-sectional study from 50,402 COVID-19 patients.

PURPOSE: Metabolic disorders have been identified as major risk factors for severe acute courses of COVID-19. With decreasing numbers of infections in many countries, the long COVID syndrome (LCS) represents the next major challenge in pandemic management, warranting the precise definition of risk factors for LCS development. METHODS: We identified 50,402 COVID-19 patients in the Disease Analyzer database (IQVIA) featuring data from 1056 general practices in Germany. Multivariate logistic regression analysis was used to identify risk factors for the development of LCS. RESULTS: Of the 50,402 COVID-19 patients included into this analysis, 1,708 (3.4%) were diagnosed with LCS. In a multivariate regression analysis, we identified lipid metabolism disorders (OR 1.46, 95% CI 1.28-1.65, p < 0.001) and obesity (OR 1.25, 95% CI 1.08-1.44, p = 0.003) as strong risk factors for the development of LCS. Besides these metabolic factors, patients' age between 46 and 60 years (compared to age ≤ 30, (OR 1.81 95% CI 1.54-2.13, p < 0.001), female sex (OR 1.33, 95% CI 1.20-1.47, p < 0.001) as well as pre-existing asthma (OR 1.67, 95% CI 1.39-2.00, p < 0.001) and depression (OR 1.27, 95% CI 1.09-1.47, p = < 0.002) in women, and cancer (OR 1.4, 95% CI 1.09-1.95, p = < 0.012) in men were associated with an increased likelihood of developing LCS. CONCLUSION: Lipid metabolism disorders and obesity represent age-independent risk factors for the development of LCS, suggesting that metabolic alterations determine the risk for unfavorable disease courses along all phases of COVID-19.

Fewer non-COVID-19 respiratory tract infections and gastrointestinal infections during the COVID-19 pandemic.

For preventing the spread of the coronavirus disease 2019 (COVID-19) pandemic, measures like wearing masks, social distancing, and hand hygiene played crucial roles. These measures may also have affected the expansion of other infectious diseases like respiratory tract infections (RTI) and gastro-intestinal infections (GII). Therefore, we aimed to investigate non-COVID-19 related RTI and GII during the COVID-19 pandemic. Patients with a diagnosis of an acute RTI (different locations) or acute GII documented anonymously in 994 general practitioner (GP) or 192 pediatrician practices in Germany were included. We compared the prevalence of acute RTI and GII between April 2019-March 2020 and April 2020-March 2021. In GP practices, 715,440 patients were diagnosed with RTI or GII in the nonpandemic period versus 468,753 in the pandemic period; the same trend was observed by pediatricians (275,033 vs. 165,127). By GPs, the strongest decrease was observed for the diagnosis of influenza (-71%, p < 0.001), followed by acute laryngitis (-64%, p < 0.001), acute lower respiratory infections (bronchitis) (-62%, p < 0.001), and intestinal infections (-40%, p < 0.001). In contrast, the relatively rare viral pneumonia strongly increased by 229% (p < 0.001). In pediatrician practices, there was a strong decrease in infection diagnoses, especially influenza (-90%, p < 0.001), pneumonia (-73%, p < 0.001 viral; -76%, p < 0.001 other pneumonias), and acute sinusitis (-66%, p < 0.001). No increase was observed for viral pneumonia in children. The considerable limitations concerning social life implemented during the COVID-19 pandemic to combat the spread of SARS-CoV-2 also resulted in an inadvertent but welcome reduction in other non-Covid-19 respiratory tract and gastro-intestinal infections.

Increased pharmacy purchases of cardiovascular drugs from wholesalers prior to the first and second COVID-19 lockdowns.

AIM: The aim of this study was to examine the development of drug purchases over the course of the coronavirus crisis in Germany in 2020. MATERIALS AND METHODS: The evaluations in this retrospective cross-sectional study are based on the IMS RPM (Regional Pharmaceutical Market) weekly database, which shows weekly purchases by public pharmacies from full-service wholesalers at the time the pharmacy purchase is made in Germany. The outcome of this investigation was the development of cardiovascular drug sales by packing unit over all 52 weeks of 2020. RESULTS: We found an increase of 68% in week 12 compared to the average sales for weeks 2 - 11, 2020 (vs. -2% in week 12, 2019), while the increase in week 51 was 61%, compared to the average sales for weeks 13 - 50, 2020 (vs. 35% in week 51, 2019). The largest increases in week 12 were for calcium channel blockers (64%), and the largest increases in week 51 were for lipid-lowering drugs (67%). CONCLUSION: The results of this retrospective cross-sectional study suggest that the COVID-19 lockdown in Germany was associated with a significant surge in pharmacy purchases of cardiovascular drugs, indicating panic buying. Although there were no drug shortages during the first lockdown, this panic buying recurred shortly before the second lockdown, albeit to a lesser extent.

Prevalence of, and factors associated with, long-term COVID-19 sick leave in working-age patients followed in general practices in Germany.

OBJECTIVES: To investigate the prevalence of, and the factors associated with, long-term sick leave in working-age patients diagnosed with COVID-19 in general practices in Germany. METHODS: Patients aged 18-65 years diagnosed with COVID-19 in any of 1255 general practices in Germany between March 2020 and February 2021 were included in the study. Long-term sick leave was defined as sick leave of at least 4 weeks. The association between predefined independent variables and long-term sick leave was studied using an adjusted logistic regression model. RESULTS: This study included 30 950 patients diagnosed with COVID-19 (51.7% women, mean (standard deviation) age 41.5 (±13.0) years). The prevalence of long-term sick leave was 5.8%. Female sex, older age, and several conditions (noninfective enteritis and colitis; reaction to severe stress, and adjustment disorders; atopic dermatitis; mononeuropathies; reflux diseases; diabetes mellitus; and hypertension) were positively and significantly associated with long-term sick leave. CONCLUSION: Long-term sick leave was relatively rare in COVID-19 patients followed in general practices in Germany. These results should be confirmed or invalidated in other settings and countries.

Consultations Decline for Stroke, Transient Ischemic Attack, and Myocardial Infarction during the COVID-19 Pandemic in Germany.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic raises the concern that other non-COVID conditions will be affected by a decline in care. Therefore, we aimed to investigate the decline in ambulatory presentations for vascular events (stroke, transient ischemic attack [TIA], and myocardial infarction [MI]) during the COVID-19 pandemic. METHODS: Patients with a diagnosis of ischemic stroke, TIA, or MI documented anonymously in 1,262 general practices in Germany were included. We studied the differences between 2019 and 2020 (between April and June) in terms of rates and baseline characteristics by comparing monthly absolute frequencies. RESULTS: A total of 3,496 patients with stroke (mean age: 72.2 years), 1,608 patients with TIA (mean age: 71.5 years), and 2,385 patients with MI (mean age: 66.8 years) were identified between April and June 2020, indicating a decrease of 10% (stroke), 16% (TIA), and 9% (MI) compared to 2019. For patients with stroke, the decrease in men was 13% (women: -6%) but reached 17% in the age category 51-60 years. For MI, the decrease was only obvious in males (14%). The largest decrease in stroke (-17%) and MI (-19%) was noted in April, while that for TIA occurred in May (-22%). In June for all 3 conditions, the previous year's level was achieved. Only in TIA, the age differs between 2019 and 2020 (mean age: 69.9 vs. 71.5 years; p < 0.05). In patients with stroke and MI, the proportions of men were lower in 2019 than in 2020 (stroke: 54.8-50.5%, p < 0.05 and MI: 64-60.2%, p < 0.05). CONCLUSION: Although the decline in the number of patients presenting with stroke, TIA, and MI was not as noticeable in the ambulatory sector as it was in the area of emergency hospital-based care, our data indicate that the COVID-19 pandemic affected all sectors within the medical care system.

Impact of the coronavirus 2019 (COVID-19) pandemic on anxiety diagnosis in general practices in Germany.

Little is known about the effects of the coronavirus disease-2019 (COVID-19) pandemic on the diagnosis of anxiety disorder. Therefore, the goal of this study was to compare the number of adults with a diagnosis of anxiety disorder and the number of adults newly diagnosed with anxiety disorder in Germany between January-June 2019 and January-June 2020, and to identify potential differences in terms of sociodemographic characteristics, prescriptions and comorbidities between these patients. The study included patients with at least one consultation in one of 1140 general practices in Germany in January-June 2019 and January-June 2020. Sociodemographic characteristics included age and sex, while there were three families of drugs and nine common comorbidities available for the analysis. An increase in the number of patients with anxiety disorder was observed in 2020 compared with 2019 (January: +4%, p = 0.643; February: +4%, p = 0.825; March: +34%, p < 0.001; April: +8%, p = 0.542; May: +2%, p = 0.382; June: +19%, p = 0.043; and March-June: + 19%, p < 0.001). There was also an increase in the number of patients newly diagnosed with anxiety disorder between March-June 2020 and March-June 2019 (11,502 versus 9506; +21%, p-value<0.001). Antidepressants, anxiolytics and herbal sedatives were less frequently prescribed in patients newly diagnosed with anxiety disorder in 2020 than in 2019 (30.4% versus 35.6%, p-value<0.001). Finally, COPD (9.4% versus 7.9%, p-value<0.001) and asthma (11.3% versus 9.7%, p-value<0.001) were more frequent in 2020 than in 2019. Taken these findings together, public health measures are urgently needed to mitigate the negative impact of the COVID-19 pandemic on anxiety disorder.