{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T16:57:13Z","timestamp":1792688233683,"version":"4.5.0"},"reference-count":35,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T00:00:00Z","timestamp":1777248000000},"content-version":"vor","delay-in-days":116,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["International Journal of Microbiology"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>We are aimed at evaluating whether the widespread use of azithromycin during the COVID\u201019 pandemic led to a significant increase in bacterial resistance compared with the prepandemic period and estimating the magnitude of this effect through a systematic review and meta\u2010analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This systematic review followed the PRISMA 2020 guidelines and Cochrane Handbook (Page,2021). Observational studies published between 2015 and 2025 reporting azithromycin resistance before and after the COVID\u201019 pandemic were identified. Odds ratios (ORs) were pooled using a random\u2010effects model. Methodological quality was assessed using the Newcastle\u2013Ottawa scale.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Eight studies met the eligibility criteria and were included in the quantitative synthesis. The meta\u2010analysis demonstrated a significant increase in azithromycin resistance in the postpandemic period, with a pooled OR of 2.71 (95% CI: 2.04\u20133.59). Substantial heterogeneity was observed (\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      = 73.5\n                      <jats:italic>%<\/jats:italic>\n                      ), justifying the use of a random\u2010effects model.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The findings provide robust evidence that the excessive and largely empirical use of azithromycin during the COVID\u201019 pandemic contributed to a global rise in bacterial resistance. Strengthening antimicrobial stewardship policies is essential to preserve the clinical effectiveness of macrolides during future public health emergencies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1155\/ijm\/8643896","type":"journal-article","created":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T08:30:09Z","timestamp":1777278609000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["From Widespread Use to Loss of Effectiveness: The Consequences of Inappropriate Azithromycin Prescriptions During the COVID\u201019 Pandemic\u2014A Systematic Review and Meta\u2010Analysis"],"prefix":"10.1155","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4456-7557","authenticated-orcid":false,"given":"Beatriz Birelli","family":"do Nascimento","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8979-8017","authenticated-orcid":false,"given":"Bianca Gianola Belline","family":"Silva","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8828-9918","authenticated-orcid":false,"given":"Leandro Aparecido","family":"de Souza","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-2311-4302","authenticated-orcid":false,"given":"Jessica Cristina Bilizario Nogueirol","family":"Andrade","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7138-0376","authenticated-orcid":false,"given":"Fernando","family":"de S\u00e1 Del Fiol","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,4,27]]},"reference":[{"key":"e_1_2_13_1_2","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1056\/NEJMoa2001017","article-title":"A Novel Coronavirus from Patients with Pneumonia in China, 2019","volume":"382","author":"Zhu N.","year":"2020","journal-title":"New England Journal of Medicine"},{"key":"e_1_2_13_2_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2001316"},{"key":"e_1_2_13_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)30251-8"},{"key":"e_1_2_13_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)30183-5"},{"key":"e_1_2_13_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijantimicag.2020.105932"},{"key":"e_1_2_13_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.tmaid.2020.101663"},{"key":"e_1_2_13_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamda.2023.05.013"},{"key":"e_1_2_13_8_2","doi-asserted-by":"publisher","DOI":"10.1370\/afm.230633"},{"key":"e_1_2_13_9_2","doi-asserted-by":"publisher","DOI":"10.1017\/ice.2024.19"},{"key":"e_1_2_13_10_2","doi-asserted-by":"publisher","DOI":"10.3389\/fphar.2022.844818"},{"key":"e_1_2_13_11_2","doi-asserted-by":"publisher","DOI":"10.3855\/jidc.17597"},{"key":"e_1_2_13_12_2","doi-asserted-by":"publisher","DOI":"10.1155\/2022\/6570812"},{"key":"e_1_2_13_13_2","doi-asserted-by":"publisher","DOI":"10.3201\/eid3014.240374"},{"key":"e_1_2_13_14_2","doi-asserted-by":"publisher","DOI":"10.1128\/MMBR.00016-10"},{"key":"e_1_2_13_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(13)70318-9"},{"key":"e_1_2_13_16_2","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.1717295115"},{"key":"e_1_2_13_17_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.m1983"},{"key":"e_1_2_13_18_2","doi-asserted-by":"publisher","DOI":"10.1002\/9781119536604.ch10"},{"key":"e_1_2_13_19_2","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"372","author":"Page M. 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