初级保健中抗生素处方的不当或过度使用凸显了抗菌药物管理（AMS）计划的机会，该计划旨在通过优化抗生素处方的教育、政策和实践审核来减少不必要的抗菌药物的使用。大流行早期的证据表明，为 COVID-19 患者开出抗生素的比例很高。从大流行开始到地方病阶段，监测初级保健提供者的抗生素处方至关重要，以了解大流行的影响并更好地针对有效的 AMS 计划。这是一项基于配对人群的队列研究，使用电子医疗来自加拿大初级保健哨兵监测网络 (CPCSSN) 的记录 (EMR) 数据。参与者包括所有曾就诊于初级保健提供者并符合 COVID-19、呼吸道感染 (RTI) 或非呼吸道疾病或流感样疾病（阴性）纳入标准的患者。评估了四种结果（a）收到抗生素处方； (b) 收到非抗生素处方； (c) 随后的初级保健就诊（出于任何原因）； (d) 随后进行初级保健就诊并诊断为细菌感染。使用条件逻辑回归来评估 COVID-19 与四种结果之间的关联。每个模型都根据地点（农村或城市）、物质和社会剥夺、吸烟状况、饮酒、肥胖、怀孕、艾滋病毒、癌症和慢性病数量进行了调整。COVID-19 患者在 30 天内接受抗生素的几率他们就诊的比例远低于因 RTI 或非呼吸道疾病或流感样疾病就诊的患者（与 RTI 相比，AOR =0.08，95% CI[0.07, 0.09]，AOR =0.43，95% CI[ 0.38, 0.48] 与负片相比）。研究发现，在所有时间点，因 COVID-19 就诊的患者后续因细菌感染就诊的可能性都要小得多。令人鼓舞的是，与 RTI 患者相比，COVID-19 患者接受抗生素处方的可能性要小得多。然而，这凸显了一个机会，可以利用 COVID-19 大流行期间公共卫生信息带来的教育和态度转变（抗生素不能治疗病毒感染），减少其他病毒性 RTI 的抗生素处方并改善抗生素管理.© 2024。作者。

Inappropriate or overuse of antibiotic prescribing in primary care highlights an opportunity for antimicrobial stewardship (AMS) programs aimed at reducing unnecessary use of antimicrobials through education, policies and practice audits that optimize antibiotic prescribing. Evidence from the early part of the pandemic indicates a high rate of prescribing of antibiotics for patients with COVID-19. It is crucial to surveil antibiotic prescribing by primary care providers from the start of the pandemic and into its endemic stage to understand the effects of the pandemic and better target effective AMS programs.This was a matched pair population-based cohort study that used electronic medical record (EMR) data from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN). Participants included all patients that visited their primary care provider and met the inclusion criteria for COVID-19, respiratory tract infection (RTI), or non-respiratory or influenza-like-illness (negative). Four outcomes were evaluated (a) receipt of an antibiotic prescription; (b) receipt of a non-antibiotic prescription; (c) a subsequent primary care visit (for any reason); and (d) a subsequent primary care visit with a bacterial infection diagnosis. Conditional logistic regression was used to evaluate the association between COVID-19 and each of the four outcomes. Each model was adjusted for location (rural or urban), material and social deprivation, smoking status, alcohol use, obesity, pregnancy, HIV, cancer and number of chronic conditions.The odds of a COVID-19 patient receiving an antibiotic within 30 days of their visit is much lower than for patients visiting for RTI or for a non-respiratory or influenza-like-illnesses (AOR = 0.08, 95% CI[0.07, 0.09] compared to RTI, and AOR = 0.43, 95% CI[0.38, 0.48] compared to negatives). It was found that a patient visit for COVID-19 was much less likely to have a subsequent visit for a bacterial infection at all time points.Encouragingly, COVID-19 patients were much less likely to receive an antibiotic prescription than patients with an RTI. However, this highlights an opportunity to leverage the education and attitude change brought about by the public health messaging during the COVID-19 pandemic (that antibiotics cannot treat a viral infection), to reduce the prescribing of antibiotics for other viral RTIs and improve antibiotic stewardship.© 2024. The Author(s).