Changes in antimicrobial prescriptions in South Korea during and beyond the coronavirus disease 2019 pandemic: An interrupted time-series analysis.

Background: Although the coronavirus pandemic significantly affected antibiotic use, studies on the long-term effects of the pandemic on antibiotic use are lacking. We aimed to investigate the changes in antibiotic prescriptions during the pandemic and subsequent endemic period in South Korea.

Methods: For this interrupted time-series study, we used claims data from the National Health Insurance System for January 2018 to December 2023. We used generalized least-squares models with the pandemic and endemic periods as interventions. We measured changes in the number of patients prescribed antibiotics, number of prescriptions, and cost of prescriptions during the pre-pandemic, pandemic, and endemic periods. Subgroup analyses were conducted according to hospital type, patient type, and antibiotic class.

Results: During the study period, 694 million patients were prescribed antibiotics. The standardized coefficient of immediate effect on the number of patients prescribed antibiotics at the start of the pandemic was -0.936 (P < .001). Abrupt decreases were followed by a gradual upslope during the endemic (0.577, P < .001). Tertiary hospitals exhibited an immediate decrease at the beginning of the pandemic (-0.869, P < .001) and early subsequent recovery during the endemic (1.491, P = .001).

Conclusions: This study may help inform flexible policies for infection control, antimicrobial stewardship, and public health improvement.