{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T00:36:04Z","timestamp":1774485364969,"version":"3.50.1"},"reference-count":28,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2023,4,1]],"date-time":"2023-04-01T00:00:00Z","timestamp":1680307200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,5,24]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>The coronavirus disease-19 pandemic and the related public health mitigation measures have impacted the transmission of infectious diseases; however, their impact on the use of antibacterials has not yet been extensively evaluated. This study evaluated the impact of the pandemic on the consumption patterns of antibacterials for systemic use in primary care in Portugal. An interrupted time-series analysis was performed using the autoregressive integrated moving average model of the antibacterials dispensed in the community pharmacies in Portugal from 1 January 2016 to 30 June 2022. Monthly rates of absolute consumption (all antibacterials for systemic use, and specifically penicillins; cephalosporins; macrolides, lincosamides, and streptogramins; and quinolones) and the relative consumption of antibacterials (penicillins sensitive to \u03b2-lactamase, penicillin combinations including \u03b2-lactamase inhibitors, third- and fourth-generation cephalosporins, fluoroquinolones, and the ratio of broad- to narrow-spectrum antibacterials) were estimated. Antibiotic consumption was expressed in defined daily doses per 1000 inhabitants per day (DID). In Portugal, the consumption of antibacterials (J01) declined sharply immediately after the beginning of the pandemic, having a significant reduction of &amp;gt;5 DID (P\u2009&amp;lt;\u2009.0001). A similar, short-term impact was found for penicillins (\u22122.920 DID; P\u2009&amp;lt;\u2009.0001); cephalosporins (\u22120.428 DID; P\u2009&amp;lt;\u2009.0001); macrolides, lincosamides, and streptogramins (\u22120.681 DID; P\u2009=\u2009.0021); and quinolones (\u22120.320 DID; P\u2009&amp;lt;\u2009.0001). A long-term increase was found for cephalosporins (+0.019 DID per month; P\u2009&amp;lt;\u2009.0001). Relative consumption changes were only found for third- and fourth-generation cephalosporins (0.0734%). Our study suggests that the coronavirus disease-19 pandemic may have resulted in a decrease in antibiotic use, with no significant changes in the relative dispense. Uncertainties regarding the long-term effects of the pandemic and its impact on the rates of resistance remain.<\/jats:p>","DOI":"10.1093\/intqhc\/mzad014","type":"journal-article","created":{"date-parts":[[2023,5,25]],"date-time":"2023-05-25T03:07:23Z","timestamp":1684984043000},"source":"Crossref","is-referenced-by-count":8,"title":["COVID-19 pandemic and the quality of antibiotic use in primary care: an interrupted time-series study"],"prefix":"10.1093","volume":"35","author":[{"given":"Mariana","family":"Domingues","sequence":"first","affiliation":[{"name":"Departamento de Farm\u00e1cia, Farmacologia e Tecnologias em Sa\u00fade, Faculdade de Farm\u00e1cia da Universidade de Lisboa , Avenida Professor Gama Pinto, Lisboa 1649-003, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5542-9993","authenticated-orcid":false,"given":"Carla","family":"Torre","sequence":"additional","affiliation":[{"name":"Laboratory of Systems Integration Pharmacology, Clinical and Regulatory Science\u2014Research Institute for Medicines of the University of Lisbon (iMED.ULisboa) , Avenida Professor Gama Pinto, Lisboa 1649-003, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jos\u00e9 Pedro","family":"Guerreiro","sequence":"additional","affiliation":[{"name":"Centre for Health Evaluation & Research (CEFAR-INFOSAUDE), National Association of Pharmacies (ANF) , R. Mal. Saldanha 1, Lisboa 1249-069, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pedro","family":"Barata","sequence":"additional","affiliation":[{"name":"Centro Hospitalar Universit\u00e1rio do Porto (CHUPorto) , Largo Prof. Abel Salazar, Porto 4099-001, Portugal"},{"name":"Faculdade de Ci\u00eancias da Sa\u00fade, Universidade Fernando Pessoa , Rua Carlos da Maia, 296, Porto 4200-150, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Margarida","family":"Correia-Neves","sequence":"additional","affiliation":[{"name":"Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho , Campus de Gualtar, Braga 4710-057, Portugal"},{"name":"ICVS\/3B\u2019s-PT Government Associate Laboratory, University of Minho , Campus de Gualtar, Braga\/Guimar\u00e3es 4710-057, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jo\u00e3o","family":"Rocha","sequence":"additional","affiliation":[{"name":"Departamento de Farm\u00e1cia, Farmacologia e Tecnologias em Sa\u00fade, Faculdade de Farm\u00e1cia da Universidade de Lisboa , Avenida Professor Gama Pinto, Lisboa 1649-003, Portugal"},{"name":"Laboratory of Systems Integration Pharmacology, Clinical and Regulatory Science\u2014Research Institute for Medicines of the University of Lisbon (iMED.ULisboa) , Avenida Professor Gama Pinto, Lisboa 1649-003, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bruno","family":"Sepodes","sequence":"additional","affiliation":[{"name":"Departamento de Farm\u00e1cia, Farmacologia e Tecnologias em Sa\u00fade, Faculdade de Farm\u00e1cia da Universidade de Lisboa , Avenida Professor Gama Pinto, Lisboa 1649-003, Portugal"},{"name":"Laboratory of Systems Integration Pharmacology, Clinical and Regulatory Science\u2014Research Institute for Medicines of the University of Lisbon (iMED.ULisboa) , Avenida Professor Gama Pinto, Lisboa 1649-003, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8161-9264","authenticated-orcid":false,"given":"Ant\u00f3nio","family":"Teixeira Rodrigues","sequence":"additional","affiliation":[{"name":"Centre for Health Evaluation & Research (CEFAR-INFOSAUDE), National Association of Pharmacies (ANF) , R. Mal. Saldanha 1, Lisboa 1249-069, Portugal"},{"name":"Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho , Campus de Gualtar, Braga 4710-057, Portugal"},{"name":"ICVS\/3B\u2019s-PT Government Associate Laboratory, University of Minho , Campus de Gualtar, Braga\/Guimar\u00e3es 4710-057, Portugal"},{"name":"Departamento de Farm\u00e1cia, Farmacologia e Tecnologias em Sa\u00fade, Faculdade de Farm\u00e1cia da Universidade de Lisboa , Avenida Professor Gama Pinto, Lisboa 1649-003, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2023,4,18]]},"reference":[{"key":"2023052503062561200_R1","article-title":"Coronavirus disease (COVID-19)","author":"World Health Organization","year":"2022"},{"key":"2023052503062561200_R2","article-title":"Weekly epidemiological update on COVID-19","author":"World Health Organization","year":"2022"},{"key":"2023052503062561200_R3","article-title":"Predicting the evolution and control of COVID-19 pandemic in Portugal","volume-title":"medRxiv","author":"Pais","year":"2020"},{"key":"2023052503062561200_R4","doi-asserted-by":"crossref","DOI":"10.3389\/fmicb.2013.00047","article-title":"The multifaceted roles of antibiotics and antibiotic resistance in nature","volume":"4","author":"Sengupta","year":"2013","journal-title":"Front Microbiol"},{"key":"2023052503062561200_R5","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2334-14-13","article-title":"A systematic review and meta-analysis of the effects of antibiotic consumption on antibiotic resistance","volume":"14","author":"Bell","year":"2014","journal-title":"BMC Infect Dis"},{"key":"2023052503062561200_R6","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1016\/S0140-6736(05)17907-0","article-title":"Outpatient antibiotic use in Europe and association with resistance: a cross-national database study","volume":"365","author":"Goossens","year":"2005","journal-title":"Lancet (London, England)"},{"key":"2023052503062561200_R7","article-title":"Antibiotic Resistance (Fact sheet)","author":"World Health Organization","year":"2020"},{"key":"2023052503062561200_R8","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1046\/j.1365-2710.2002.00430.x","article-title":"Segmented regression analysis of interrupted time series studies in medication use research","volume":"27","author":"Wagner","year":"2002","journal-title":"J Clin Pharm Ther"},{"key":"2023052503062561200_R9","first-page":"348","article-title":"Interrupted time series regression for the evaluation of public health interventions: a tutorial","volume":"46","author":"Bernal","year":"2017","journal-title":"Int J Epidemiol"},{"key":"2023052503062561200_R10","article-title":"COVID-19: allow pharmacists to dispense controlled drugs without prescription, urge specialists","volume":"369","author":"Iacobucci","year":"2020","journal-title":"BMJ"},{"key":"2023052503062561200_R11","article-title":"Statistics Portugal \u2013 Resident population (No.) by Place of residence (NUTS \u2013 2013), Sex and Age group; Annual (2020)","author":"Portuguese Institute of National Statistics","year":"2022"},{"key":"2023052503062561200_R12","doi-asserted-by":"crossref","first-page":"440","DOI":"10.1136\/qshc.2006.021121","article-title":"European Surveillance of Antimicrobial Consumption (ESAC): quality indicators for outpatient antibiotic use in Europe","volume":"16","author":"Coenen","year":"2007","journal-title":"Qual Saf Health Care"},{"key":"2023052503062561200_R13","doi-asserted-by":"crossref","DOI":"10.1186\/s12874-021-01235-8","article-title":"Interrupted time series analysis using autoregressive integrated moving average (ARIMA) models: a guide for evaluating large-scale health interventions","volume":"21","author":"Schaffer","year":"2021","journal-title":"BMC Med Res Methodol"},{"key":"2023052503062561200_R14","article-title":"Ponto de Situa\u00e7\u00e3o Atual em Portugal \u2013 COVID-19","author":"General Directorate of Health","year":"2022"},{"key":"2023052503062561200_R15","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1002\/jrsm.1435","article-title":"Creating effective interrupted time series graphs: review and recommendations","volume":"12","author":"Turner","year":"2021","journal-title":"Res Synth Methods"},{"key":"2023052503062561200_R16","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1002\/pds.1244","article-title":"Antibiotic use in ambulatory care in Europe (ESAC data 1997\u20132002): trends, regional differences and seasonal fluctuations","volume":"16","author":"Elseviers","year":"2007","journal-title":"Pharmacoepidemiol Drug Saf"},{"key":"2023052503062561200_R17","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1093\/cid\/cis509","article-title":"Seasonality and temporal correlation between community antibiotic use and resistance in the United States","volume":"55","author":"Sun","year":"2012","journal-title":"Clin Infect Dis an off Publ Infect Dis Soc Am"},{"key":"2023052503062561200_R18","article-title":"10 global health issues to track in 2021","author":"World Health Organization","year":"2021"},{"key":"2023052503062561200_R19","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1111\/irv.12824","article-title":"Influenza and COVID-19: what does co-existence mean?","volume":"15","author":"Chotpitayasunondh","year":"2021","journal-title":"Influenza Other Respi Viruses"},{"key":"2023052503062561200_R20","doi-asserted-by":"crossref","first-page":"1933","DOI":"10.3201\/eid2608.201229","article-title":"Decreased influenza incidence under COVID-19 control measures, Singapore","volume":"26","author":"Soo","year":"2020","journal-title":"Emerg Infect Dis"},{"key":"2023052503062561200_R21","doi-asserted-by":"crossref","first-page":"548","DOI":"10.1016\/j.ijid.2020.05.069","article-title":"Positive effects of COVID-19 control measures on pneumonia prevention","volume":"96","author":"Wu","year":"2020","journal-title":"Int J Infect Dis"},{"key":"2023052503062561200_R22","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1177\/2054270417717668","article-title":"Factors associated with antibiotic prescriptions for the viral origin diseases in office-based practices, 2006\u20132012","volume":"8","author":"Imanpour","year":"2017","journal-title":"JRSM Open"},{"key":"2023052503062561200_R23","doi-asserted-by":"crossref","first-page":"1864","DOI":"10.1001\/jama.2016.4151","article-title":"Prevalence of inappropriate antibiotic prescriptions among US ambulatory care visits, 2010\u20132011","volume":"315","author":"Fleming-Dutra","year":"2016","journal-title":"JAMA"},{"key":"2023052503062561200_R24","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1003682","article-title":"Sales of antibiotics and hydroxychloroquine in India during the COVID-19 epidemic: an interrupted time series analysis","volume":"18","author":"Sulis","year":"2021","journal-title":"PLoS Med"},{"key":"2023052503062561200_R25","doi-asserted-by":"crossref","first-page":"e652","DOI":"10.1093\/cid\/ciaa1896","article-title":"Trends in US outpatient antibiotic prescriptions during the coronavirus disease 2019 pandemic","volume":"73","author":"King","year":"2021","journal-title":"Clin Infect Dis"},{"key":"2023052503062561200_R26","article-title":"The GP Insights Series No 7: Primary Care and SARS-CoV-2: the first 40 weeks of the pandemic year","author":"Pearce","year":"2020"},{"key":"2023052503062561200_R27","doi-asserted-by":"crossref","first-page":"2247","DOI":"10.1093\/jac\/dkq309","article-title":"European Surveillance of Antibiotic Consumption (ESAC) point prevalence survey 2008: paediatric antimicrobial prescribing in 32 hospitals of 21 European countries","volume":"65","author":"Amadeo","year":"2010","journal-title":"J Antimicrob Chemother"},{"key":"2023052503062561200_R28","first-page":"401","article-title":"Inappropriate antibiotic prescription for respiratory tract indications: most prominent in adult patients","volume":"32","author":"Dekker","year":"2015","journal-title":"Fam Pract"}],"container-title":["International Journal for Quality in Health Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/intqhc\/article-pdf\/35\/2\/mzad014\/50449002\/mzad014.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/intqhc\/article-pdf\/35\/2\/mzad014\/50449002\/mzad014.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,5,25]],"date-time":"2023-05-25T03:07:37Z","timestamp":1684984057000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/intqhc\/article\/doi\/10.1093\/intqhc\/mzad014\/7179254"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,4,1]]},"references-count":28,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2023,5,24]]}},"URL":"https:\/\/doi.org\/10.1093\/intqhc\/mzad014","relation":{},"ISSN":["1353-4505","1464-3677"],"issn-type":[{"value":"1353-4505","type":"print"},{"value":"1464-3677","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2023,4,1]]},"published":{"date-parts":[[2023,4,1]]},"article-number":"mzad014"}}