{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,29]],"date-time":"2025-09-29T11:41:34Z","timestamp":1759146094215,"version":"3.41.2"},"reference-count":32,"publisher":"American Society for Microbiology","issue":"4","license":[{"start":{"date-parts":[[2025,4,1]],"date-time":"2025-04-01T00:00:00Z","timestamp":1743465600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,4,1]],"date-time":"2025-04-01T00:00:00Z","timestamp":1743465600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"funder":[{"name":"Pfizer, Inc"}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["Microbiol Spectr"],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n          <jats:sec>\n            <jats:title\/>\n            <jats:p>Coronavirus disease 2019 (COVID-19) has complicated the management of acute respiratory infections and impacted antibiotic use. We assessed the relationship between nirmatrelvir\/ritonavir (NMV\/r) receipt and outpatient antibiotic prescribing among patients with COVID-19 in a large national health system. We conducted a retrospective cohort study among outpatients enrolled in the Veterans Affairs Healthcare System who had a positive severe acute respiratory syndrome coronavirus 2 test or COVID-19 diagnosis and were eligible for NMV\/r treatment between 1 April 2022 and 31 March 2024. NMV\/r-treated patients were compared with those who did not receive NMV\/r and were considered unexposed until NMV\/r was dispensed. We assessed the relationship between NMV\/r receipt and being prescribed an outpatient antibiotic in the 30 days after a COVID-19 diagnosis using adjusted Cox proportional hazards regression. We included 302,600 NMV\/r-eligible outpatients with COVID-19, of whom 67,649 received NMV\/r and 234,951 did not receive NMV\/r. NMV\/r-treated patients were less likely to receive outpatient antibiotics compared to those who did not receive NMV\/r (7.2% [4,901\/67,649] vs 9.2% [21,533\/234,951], respectively; adjusted hazard ratio [HR] 0.65, 95% CI: 0.63\u20120.68). After excluding patients who received an antibiotic prescription upon COVID-19 diagnosis (i.e., likely empiric therapy), this relationship was attenuated (HR: 0.91, 95% CI: 0.87\u20120.95). NMV\/r-eligible patients with COVID-19 who received NMV\/r were 35% less likely to be prescribed outpatient antibiotics compared to patients who did not receive NMV\/r, possibly driven by a diminished perceived need for empiric antibiotic therapy. Treatment with NMV\/r may reduce unnecessary outpatient antibiotic use. Antibiotics should be reserved for patients with a high suspicion of bacterial co-infection.<\/jats:p>\n            <jats:sec>\n              <jats:title>IMPORTANCE<\/jats:title>\n              <jats:p>Antimicrobial resistance, driven by the overuse of antibiotics, is a major global health threat. The coronavirus disease 2019 (COVID-19) pandemic has complicated this issue, with antibiotics often prescribed to patients with COVID-19 despite being ineffective against viruses. These practices, typically aimed at preventing or empirically treating rare bacterial co-infections, have raised concerns about accelerating resistance. The antiviral nirmatrelvir\/ritonavir (NMV\/r), widely used in high-risk patients with COVID-19 to prevent severe illness, offers an opportunity to reassess antibiotic use in patients with respiratory infections. Our study of over 300,000 patients in a national healthcare system found that those treated with NMV\/r for COVID-19 were 35% less likely to receive antibiotics than those who did not receive the antiviral. Lower antibiotic use among patients treated with NMV\/r may reflect a reduction in unnecessary outpatient antibiotic use. These findings highlight the potential role of antivirals in supporting antibiotic stewardship and addressing a critical public health challenge.<\/jats:p>\n            <\/jats:sec>\n          <\/jats:sec>","DOI":"10.1128\/spectrum.03209-24","type":"journal-article","created":{"date-parts":[[2025,3,5]],"date-time":"2025-03-05T14:02:14Z","timestamp":1741183334000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":1,"title":["Association between nirmatrelvir\/ritonavir treatment and antibiotic prescribing in the outpatient setting among patients with COVID-19"],"prefix":"10.1128","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4180-027X","authenticated-orcid":true,"given":"Aisling R.","family":"Caffrey","sequence":"first","affiliation":[{"name":"Infectious Diseases Research Program, Providence Veterans Affairs Medical Center","place":["Providence, USA"]},{"name":"Center of Innovation in Long-Term Support Services, Providence Veterans Affairs Medical Center","place":["Providence, USA"]},{"name":"College of Pharmacy, University of Rhode Island","place":["Kingston, USA"]},{"name":"School of Public Health, Brown University","place":["Providence, USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2407-7032","authenticated-orcid":true,"given":"Haley J.","family":"Appaneal","sequence":"additional","affiliation":[{"name":"Infectious Diseases Research Program, Providence Veterans Affairs Medical Center","place":["Providence, USA"]},{"name":"Center of Innovation in Long-Term Support Services, Providence Veterans Affairs Medical Center","place":["Providence, USA"]},{"name":"College of Pharmacy, University of Rhode Island","place":["Kingston, USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vrishali V.","family":"Lopes","sequence":"additional","affiliation":[{"name":"Infectious Diseases Research Program, Providence Veterans Affairs Medical Center","place":["Providence, USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Lavoie","sequence":"additional","affiliation":[{"name":"Infectious Diseases Research Program, Providence Veterans Affairs Medical Center","place":["Providence, USA"]},{"name":"College of Pharmacy, University of Rhode Island","place":["Kingston, USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura","family":"Puzniak","sequence":"additional","affiliation":[{"name":"Pfizer Inc.","place":["New York, USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Evan J.","family":"Zasowski","sequence":"additional","affiliation":[{"name":"Pfizer Inc.","place":["New York, USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luis","family":"Jodar","sequence":"additional","affiliation":[{"name":"Pfizer Inc.","place":["New York, USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Iqra","family":"Arham","sequence":"additional","affiliation":[{"name":"Pfizer Inc.","place":["New York, USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9650-4275","authenticated-orcid":true,"given":"Kerry L.","family":"LaPlante","sequence":"additional","affiliation":[{"name":"Infectious Diseases Research Program, Providence Veterans Affairs Medical Center","place":["Providence, USA"]},{"name":"Center of Innovation in Long-Term Support Services, Providence Veterans Affairs Medical Center","place":["Providence, USA"]},{"name":"College of Pharmacy, University of Rhode Island","place":["Kingston, USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John M.","family":"McLaughlin","sequence":"additional","affiliation":[{"name":"Pfizer Inc.","place":["New York, USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"235","reference":[{"key":"e_1_3_5_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmi.2020.12.018"},{"key":"e_1_3_5_3_2","doi-asserted-by":"publisher","DOI":"10.3390\/v16071005"},{"key":"e_1_3_5_4_2","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofad096"},{"key":"e_1_3_5_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmi.2020.07.041"},{"key":"e_1_3_5_6_2","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciaa530"},{"key":"e_1_3_5_7_2","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciaa1239"},{"key":"e_1_3_5_8_2","doi-asserted-by":"publisher","DOI":"10.3390\/antibiotics12010045"},{"key":"e_1_3_5_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(23)00118-4"},{"key":"e_1_3_5_10_2","doi-asserted-by":"publisher","DOI":"10.7326\/M22-3565"},{"key":"e_1_3_5_11_2","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkae042"},{"key":"e_1_3_5_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(23)00011-7"},{"key":"e_1_3_5_13_2","unstructured":"Centerss for Disease Control and Prevention. 2019. Interim clinical considerations for COVID-19 treatment and pre-exposure prophylaxis in outpatients. Available from: https:\/\/www.cdc.gov\/coronavirus\/2019-ncov\/hcp\/clinical-care\/outpatient-treatment-overview.html. Retrieved 12 Jun 2024."},{"key":"e_1_3_5_14_2","unstructured":"Pfizer. Emergency Use Authorization (EUA) of Paxlovid for Coronavirus Disease 2019 (COVID-19). Available from: https:\/\/www.fda.gov\/media\/155051\/download. Retrieved 1 Aug 2022."},{"key":"e_1_3_5_15_2","unstructured":"Centers for Disease Control and Prevention. Underlying medical conditions associated with higher risk for severe COVID-19: information for healthcare professionals. Available from: https:\/\/www.cdc.gov\/coronavirus\/2019-ncov\/hcp\/clinical-care\/underlyingconditions.html. Retrieved 1 Aug 2022."},{"key":"e_1_3_5_16_2","unstructured":"University of Liverpool. COVID-19 drug interactions checker. Available from: https:\/\/www.covid19-druginteractions.org\/checker. 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