Two recent CDC publications show antibiotic prescribing during the COVID-19 pandemic decreased across outpatient and nursing home settings. The studies show a 33% decrease in antibiotic prescribing in outpatient settings during the COVID-19 pandemic and an overall decrease in antibiotic use among nursing home residents. However, prescribing of specific antibiotics, including azithromycin, was higher than expected.

From January-May 2020, antibiotic prescribing decreased substantially in outpatient settings, likely due to:

• A decrease in the spread of non-COVID-19 respiratory diseases (e.g., common cold, flu)
• Changes in outpatient healthcare access and use, including decreases in in-person visits and increases in telehealth visits
• Increased awareness that antibiotics don’t treat viruses

Overall, antibiotic prescribing in nursing homes declined from May-October 2020, which may be attributed to these factors:

• Changes in nursing home resident population during the pandemic, including declines in nursing home admissions
• Increased awareness and improved implementation of infection prevention and control measures

Although overall antibiotic prescribing decreased, prescribing of specific antibiotics, including azithromycin, was higher than expected. In the outpatient setting, azithromycin prescribing was higher than expected, especially in geographic areas with high numbers of COVID-19 cases, which may have reflected its early promotion as a potential therapy, despite its ineffectiveness. In nursing home settings, azithromycin prescribing remained elevated through October 2020.

Patients who develop secondary bacterial infections after COVID-19 infection may require antibiotic treatment, but current data suggest this occurs in only 6.9% of patients presenting to hospitals with a current or recent COVID-19 diagnosis.

Antibiotics do not treat SARS-CoV-2, the respiratory virus that causes COVID-19. Because antibiotics have the potential to cause harm, healthcare providers should only prescribe antibiotics for patients when they are clinically indicated. CDC continues to encourage clinicians to keep their patients safe by carefully weighing the risks and benefits when prescribing antibiotics to optimize treatment of infections, minimize adverse events, and fight antibiotic resistance.

To learn more about antibiotic prescribing and use, visit www.cdc.gov/antibiotic-use.