Trends in Antibiotic Use Among Adults Hospitalized for COVID-19 and Viral Respiratory Infections

Overview

This study analyzed antibiotic prescribing trends from 2019 to 2023 among adults hospitalized with symptomatic COVID-19 and other viral acute respiratory tract infections (ARTIs) across 803 US hospitals. Initial antibiotic use was high (>80% for COVID-19 and nearly 70% for other viral ARTIs) but declined over time, stabilizing around 35% for COVID-19 and returning to pre-pandemic seasonal patterns (~50%) for other viral ARTIs by 2023.

Background

Antibiotic overuse in viral ARTIs is a major public health concern due to its contribution to antibiotic resistance and adverse patient outcomes. The COVID-19 pandemic disrupted antimicrobial stewardship, leading to increased antibiotic prescribing despite low rates of bacterial coinfection. Understanding prescribing patterns during the pandemic can inform stewardship efforts to reduce unnecessary antibiotic use. This study focused on potentially unnecessary antibiotic prescribing in hospitalized adults with symptomatic COVID-19 and non–COVID-19 viral ARTIs.

Data Highlights

Key Findings

• Over 80% of hospitalized COVID-19 patients received antibiotics at pandemic onset despite low bacterial coinfection rates (5%–10%).
• Antibiotic prescribing for other viral ARTIs increased to nearly 70% early in the pandemic.
• Antibiotic use declined over time, stabilizing at approximately 35% for COVID-19 admissions by 2022–2023.
• Prescribing for non–COVID-19 viral ARTIs returned to pre-pandemic seasonal patterns (~50%) by 2023.
• Potentially unnecessary antibiotic prescribing remains a significant stewardship target in viral ARTIs.
• Exclusion of cases with diagnoses warranting antibiotics ensured focus on potentially unnecessary prescribing.

Clinical Implications

Clinicians should be aware that despite improvements, unnecessary antibiotic use in viral respiratory infections remains prevalent and contributes to antimicrobial resistance and patient harm. Stewardship programs must continue to target antibiotic prescribing in hospitalized patients with viral ARTIs, including COVID-19, emphasizing diagnostic accuracy and limiting antibiotics to cases with clear bacterial indications. Ongoing monitoring of prescribing trends can guide interventions during current and future respiratory virus outbreaks.

Conclusion

Although antibiotic prescribing for viral ARTIs decreased since the early COVID-19 pandemic, rates remain elevated, underscoring the need for sustained antimicrobial stewardship efforts to reduce unnecessary antibiotic use in hospitalized patients with viral respiratory infections.

References

1. Garibaldi et al 2021 -- Defining symptomatic COVID-19 for clinical studies
2. Wattles et al 2022 -- Tiered ICD-10 framework for antibiotic necessity
3. Chua et al 2020 -- Antibiotic prescribing framework for ICD-10-CM
4. CDC 2019 -- Antibiotic stewardship guidelines
5. Premier Healthcare Database -- Data source for US hospital admissions