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This increaesed prescribing pattern was mentioned in an article in Lancet

https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30917-8/fulltext

I do antibiotic use reports for my facility. During the early months of COVID-19, we were also using hydroxychloroquine, which may show up in some reports as antimicrobial agents. There was also an increase in the use of azithromycin when it was thought to be beneficial for COVID-19.

That aside, without the benefit of physical exam (to listen to lungs for example) or lab tests (to check UA or obtain CBC for example), I think most clinicians would air on the side of caution if an infection is suspected and treat with antibiotics when assessing a patient remotely.

Thanks so much for your answer and comment

People are scared of visiting hospitals and laboratories. Thus, difficult to assess according to investigations. Many physicians do not examine patients properly and thus they also try to cover up by prescribing antibiotics. When one cannot determine whether it is due to a virus or bacteria, they take the benefit of the doubt as patients are benefited if it is due to a bacteria and it will alleviate the fear of COVID-19.

Thanks so much for your answer

I am a solo rural GP. During the Covid-19 pandemic most of the antibiotics I am using are: Amoxicillin + Ac. Clavulanico and Azitromicin 500 mg cp

Thanks for your answer and comment

People are scared of visiting hospitals and laboratories. Thus, difficult to assess according to investigations. Many physicians do not examine patients properly and thus they also try to cover up by prescribing antibiotics. When one cannot determine whether it is due to a virus or bacteria, they take the benefit of the doubt as patients are benefited if it is due to a bacteria and it will alleviate the fear of COVID-19

In many areas, the COVID-19 outbreak required lockdowns and limited access to hospitals, particularly for people with non-emergent symptoms and medical check-up was also canceled or postponed. In fact, avoidance of medical care is a significant factor in this regard.

The use of antibiotic rates are higher tha before.In case of COVID19, as doctors has clinical judgement by listening their complaints and having no physcial examination, end result is the antibiotic addition eoth other drugs to be on safer side to prevent secondary bacterial infections after viral infection.

Remote consultation is a double edged sword....so a physician who is being consulted online has to give emperical coverage rather being specific coz saving life is more than being precise in your treatment...In addition to this one can never be sure when a covid 19 positive patient contracts superadded bacterial infection on account of administration of steroids as a part of treatment regimen...

Thanks so much for your answer

The use of antibiotics during consultation in the remote area is higher during the pandemic because many appointment visits to the hospital for minor ailments are canceled by both patients and the Physician for two main reasons:

The patients are afraid of engaging themselves in high risk zone for covid -19, so they choose online consultation above the physical, which of course will not provide enough means for proper examination and investigation to arrive at a more appropriate diagnosis or discover associated illnesses. For the Clinician to provide a seemingly satisfactory service, he prescribes antibiotics a lot among other drugs.

Also, on the Physician's part, they advise that patients with chronic diseases which are however stable, should reduce their hospital visits especially if the main aim is for drug refill and medical checkups. This is to enhance the provision of more attention to emergencies, which the pandemic constitutes significantly. Virtual consultation is however encourage for common infections with the prescription of medications , e.g., antibiotics , which often time might not be needed if proper examination is carried out. Needless to say, this misuse is one of the main reasons why antibiotics resistance is growing day by day in our clinical practice.

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The replies here are true however they need a deeper explanation.

Current therapies that are still a standard for moderate to critical disease manifestations of SARS COV2 infection remain to be O2 and Dexamethasone as the first line of action when these patients begin to be compromised. The reasons that an antimicrobic, especially in rural areas where healthcare is inept, should be for the following.

1. There is a movement for moderate cases of Covid that do not need mechanical intervention to be treated at home due to the overwhelming of the healthcare system as of today 1/2021. The treatment still remains to be dexamethasone and O2 as the lungs become compromised. Dexamethasone obviously lowers the immunity while calming the cytokine storm or the overzealous immune system. There is an advantageous opportunity here to begin empirical antimicrobics for that reason and:

2. The moderate Covid patient and above will inevitably become hypoxic due to a mass shedding of virus in these patients who more than likely have an increased ACE2 expression thusly infecting more lung cells. This also causes a potential bacterial overgrowth where there is an opportunity to cover with an empirical antimicrobic. And especially in the rural setting, this could be both advantageous if not life-saving.

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Antibiotics work against bacteria, not viruses. In order to diagnose the sources of diseases and determine whether the source is a bacterial or viral infection, it is necessary to perform appropriate tests. However, conducting these tests remotely via the Internet is difficult.

Best wishes,

Dariusz Prokopowicz

Agreed

With a reduction in foot fall in the surgeries, clinicians are having to depend more on patients symptoms. Use of aids such as FeverPain can help with photos and video calls and the use of standby antibiotics. But overall I think that we have a lower threshold to prescribe antibiotics

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First, may I ask what is your point of comparison. Are you comparing remote vs face to face consultations during the COVID19 pandemic, or are you comparing pre-COVID19 with COVID19 consultations?

In the Australian general practice context, remote consultations were only readily available since March 2020, and we lack experience with teleconsults. Also, we have not able to physically exam our patients. I would guess that GPs became naturally more "cautious". For a reasonable number of GPs, caution translates to giving antibiotics "just in case".

Hope this helps

Darren

Thanks so much for your answer and comment