Antibiotic Prescription Patterns in the Post-COVID-19 Era in Six European Countries: A Cross-Sectional Study.

Background/objective: After the relaxation of acute containment measures during the COVID-19 pandemic, Europe experienced a substantial rebound of non-COVID infections surpassing pre-pandemic levels and causing significant clinical burden. The aim of our study is to analyze outpatient prescription data in Germany, France, Italy, Belgium, the UK, and Poland in order to assess trends and disparities in the post-COVID landscape.

Methods: The present cross-sectional study utilized data from six independently collected datasets containing details from longitudinal prescription (LRx) databases. We aimed to evaluate changes in the number of antibiotic prescriptions issued in 2022 (the first post-pandemic year) compared to 2021 (a pandemic year), as well as subsequent developments in 2023 and 2024. Analyses were stratified by age group and by sex. In addition, the most frequently prescribed antibiotics in each year and country were reported.

Results: All countries experienced a marked increase in antibiotic use in 2022 compared to 2021. The year-on-year growth in 2022 ranged from +12.0% in France to a substantial +39.3% in Belgium. Germany, Poland, and the UK also showed strong increases of over 25%, while Italy rose by 21.5%. Growth slowed in 2023 and stabilized or declined in 2024, particularly in Poland, Italy, and Belgium. Pediatric antibiotic use surged in 2022, especially among children under 10 (+75% in the UK), then leveled off and even declined in some cases in 2024, while the number of antibiotic prescriptions in older adults either decreased or increased only slightly. Germany and the UK showed continued pediatric antibiotic use increases through 2023. Amoxicillin dominated prescriptions in most countries, but drug choice patterns varied widely by country.

Conclusions: This study shows a clear increase in outpatient antibiotic prescriptions issued across Europe after the COVID-19 pandemic, particularly among children and teenagers. Although the overall trends are now starting to level out, some countries still show rising numbers. These findings underscore the importance of a renewed focus on antibiotic stewardship programs, particularly in outpatient and primary care settings.