Objective:

To compare potentially unnecessary antibiotic prescribing over time among patients admitted with symptomatic COVID-19 and non–COVID-19 viral acute respiratory tract infections (ARTIs), highlighting the significance of this comparison.

Key Findings:

• Over 80% of COVID-19 patients received antibiotics at the pandemic's onset, with nearly 70% for other viral ARTIs, indicating a significant overprescribing trend.
• Antibiotic prescribing for COVID-19 stabilized around 35% in 2022-2023, while prescribing for other viral ARTIs returned to 2019 levels at around 50%, suggesting improvements in stewardship.
• Despite improvements, unnecessary antibiotic prescribing remains a significant concern for both COVID-19 and non–COVID-19 viral ARTIs, necessitating ongoing monitoring.

Interpretation:

The study highlights the ongoing challenge of antibiotic overprescribing in viral infections, emphasizing the need for improved antibiotic stewardship, especially in the context of future pandemics, and providing specific recommendations for practice.

Limitations:

• The study only included data from hospitals contributing to the Premier Healthcare Database, which may not represent all U.S. hospitals, potentially limiting generalizability.
• Potential misclassification of antibiotic necessity due to reliance on ICD-10 codes, which may introduce bias in the assessment of prescribing practices.

Conclusion:

While antibiotic prescribing patterns have improved since the early pandemic, there remains a critical need for continued efforts in antimicrobial stewardship to address unnecessary antibiotic use in hospitalized patients with viral infections, with implications for future research and policy.