{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T22:09:40Z","timestamp":1790633380485,"version":"4.1.0"},"reference-count":35,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2024,1,20]],"date-time":"2024-01-20T00:00:00Z","timestamp":1705708800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Ministry of Innovation and Technology of Hungary from the National Research, Development and Innovation Fund","award":["ITM NKFIA TKP2021-EGA-32"],"award-info":[{"award-number":["ITM NKFIA TKP2021-EGA-32"]}]},{"name":"J\u00e1nos Bolyai Research Scholarship of the Hungarian Academy of Science","award":["ITM NKFIA TKP2021-EGA-32"],"award-info":[{"award-number":["ITM NKFIA TKP2021-EGA-32"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>The aim of this study was to assess antibiotic use in the Hungarian hospital care sector during and before the pandemic. Aggregated systemic antibiotic (ATC: J01) utilisation data were obtained for the 2010\u20132021 period. Classifications and calculations were performed according to the WHO ATC\/DDD index and expressed as DDD per 1000 inhabitants and per day (DID), DDD per 100 patient-days (DHPD) and DDD\/discharge. A linear regression (trend analysis) was performed for the pre-COVID years (2010\u20132019) and a prediction interval was set up to assess whether the pandemic years\u2019 observed utilisation fit in. Antibiotic utilisation was constant in DID before and during the pandemic (2019: 1.16; 2020: 1.21), while we observed a substantial increase in antibiotic use when expressed in DDD per 100 patient-days (2019: 23.3, 2020: 32.2) or DDD\/discharge (2019: 1.83, 2020: 2.45). The observed utilisation level of penicillin combinations; first-, third- and fourth-generation cephalosporins; carbapenems; glycopeptides; nitroimidazoles and macrolides exceeded the predicted utilisation values in both pandemic years. Before the pandemic, co-amoxiclav headed the top list of antibiotic use, while during the pandemic, ceftriaxone became the most widely used antibiotic. Azithromycin moved up substantially on the top list of antibiotic use, with a 397% increase (2019: 0.45; 2020: 2.24 DHPD) in use. In summary, the pandemic had a major impact on the scale and pattern of hospital antibiotic use in Hungary.<\/jats:p>","DOI":"10.3390\/antibiotics13010102","type":"journal-article","created":{"date-parts":[[2024,1,22]],"date-time":"2024-01-22T03:50:22Z","timestamp":1705895422000},"page":"102","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Hospital Antibiotic Consumption before and during the COVID-19 Pandemic in Hungary"],"prefix":"10.3390","volume":"13","author":[{"given":"Rox\u00e1na","family":"Ruzsa","sequence":"first","affiliation":[{"name":"Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary"},{"name":"University Pharmacy Albert Szent-Gy\u00f6rgyi Health Center, University of Szeged, 6725 Szeged, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8009-8962","authenticated-orcid":false,"given":"Ria","family":"Benk\u0151","sequence":"additional","affiliation":[{"name":"Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary"},{"name":"University Pharmacy Albert Szent-Gy\u00f6rgyi Health Center, University of Szeged, 6725 Szeged, Hungary"},{"name":"Department of Emergency Medicine, Albert Szent-Gy\u00f6rgyi Health Center, University of Szeged, 6725 Szeged, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helga","family":"Hambalek","sequence":"additional","affiliation":[{"name":"Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary"},{"name":"University Pharmacy Albert Szent-Gy\u00f6rgyi Health Center, University of Szeged, 6725 Szeged, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erika","family":"Papfalvi","sequence":"additional","affiliation":[{"name":"Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary"},{"name":"Department of Emergency Medicine, Albert Szent-Gy\u00f6rgyi Health Center, University of Szeged, 6725 Szeged, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4088-3333","authenticated-orcid":false,"given":"Dezs\u0151","family":"Csupor","sequence":"additional","affiliation":[{"name":"Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary"},{"name":"Institute of Translational Medicine, Medical School, University of P\u00e9cs, 7624 P\u00e9cs, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R\u00f3bert","family":"Nacsa","sequence":"additional","affiliation":[{"name":"Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary"},{"name":"University Pharmacy Albert Szent-Gy\u00f6rgyi Health Center, University of Szeged, 6725 Szeged, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M\u00e1rta","family":"Csatordai","sequence":"additional","affiliation":[{"name":"Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary"},{"name":"University Pharmacy Albert Szent-Gy\u00f6rgyi Health Center, University of Szeged, 6725 Szeged, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gy\u00f6ngyv\u00e9r","family":"So\u00f3s","sequence":"additional","affiliation":[{"name":"Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2309-3532","authenticated-orcid":false,"given":"Edit","family":"Hajd\u00fa","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Infectiology Unit, Albert Szent-Gy\u00f6rgyi Health Centre, University of Szeged, 6725 Szeged, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7877-2399","authenticated-orcid":false,"given":"M\u00e1ria","family":"Matuz","sequence":"additional","affiliation":[{"name":"Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary"},{"name":"University Pharmacy Albert Szent-Gy\u00f6rgyi Health Center, University of Szeged, 6725 Szeged, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,1,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1314","DOI":"10.1038\/s41591-022-01750-1","article-title":"COVID-19 and resilience of healthcare systems in ten countries","volume":"28","author":"Arsenault","year":"2022","journal-title":"Nat. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1093\/aje\/kwab252","article-title":"Corresponding author IN IT SC IT SC 2. Pressure on the Health-Care System and Intensive Care Utilization During the COVID-19 Outbreak in the Lombardy Region of Italy: A Retrospective Observational Study in 43,538 Hospitalized Patients","volume":"191","author":"Trentini","year":"2022","journal-title":"Am. J. Epidemiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"594117","DOI":"10.3389\/fpubh.2020.594117","article-title":"Reduced Rate of Inpatient Hospital Admissions in 18 German University Hospitals during the COVID-19 Lockdown","volume":"8","author":"Kapsner","year":"2021","journal-title":"Front. Public Health"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"n1135","DOI":"10.1136\/bmj.n1135","article-title":"Hospital admission and mortality rates for non-covid diseases in Denmark during COVID-19 pandemic: Nationwide population based cohort study","volume":"373","author":"Bodilsen","year":"2021","journal-title":"BMJ"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"808","DOI":"10.1016\/j.cmi.2020.04.024","article-title":"COVID-19: Don\u2019t neglect antimicrobial stewardship principles!","volume":"26","author":"Huttner","year":"2020","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e135","DOI":"10.1016\/S2666-5247(21)00039-2","article-title":"COVID-19 drug practices risk antimicrobial resistance evolution","volume":"2","author":"Afshinnekoo","year":"2021","journal-title":"Lancet Microbe"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Perrella, A., Fortinguerra, F., Pierantozzi, A., Capoluongo, N., Carannante, N., Lo Vecchio, A., Bernardi, F.F., Trotta, F., and Cangini, A. (2023). Hospital Antibiotic Use during COVID-19 Pandemic in Italy. Antibiotics, 12.","DOI":"10.3390\/antibiotics12010168"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2713","DOI":"10.1093\/jac\/dkac247","article-title":"Impact of the COVID-19 pandemic on hospital antimicrobial consumption in Croatia","volume":"77","year":"2022","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Andrews, A., Budd, E.L., Hendrick, A., Ashiru-Oredope, D., Beech, E., Hopkins, S., Gerver, S., Muller-Pebody, B., and the AMU COVID-19 Stakeholder Group (2021). Surveillance of antibacterial usage during the COVID-19 pandemic in England, 2020. Antibiotics, 10.","DOI":"10.3390\/antibiotics10070841"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Nakitanda, A.O., Karlsson, P., L\u00f6fling, L., Cesta, C.E., and Odsbu, I. (2022). Antimicrobial use in Sweden during the COVID-19 pandemic: Prescription fill and inpatient care requisition patterns. BMC Infect. Dis., 22.","DOI":"10.1186\/s12879-022-07405-3"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Friedli, O., Gasser, M., Cusini, A., Fulchini, R., Vuichard-Gysin, D., Tobler, R.H., Wassilew, N., Pl\u00fcss-Suard, C., and Kronenberg, A. (2022). Impact of the COVID-19 Pandemic on Inpatient Antibiotic Consumption in Switzerland. Antibiotics, 11.","DOI":"10.3390\/antibiotics11060792"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1007\/s43440-023-00479-z","article-title":"Hospital antibiotic consumption\u2014An interrupted time series analysis of the early and late phases of the COVID-19 pandemic in Poland, a retrospective study","volume":"75","author":"Siewierska","year":"2023","journal-title":"Pharmacol. Rep."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Grau, S., Hern\u00e1ndez, S., Echeverr\u00eda-Esnal, D., Almendral, A., Ferrer, R., Lim\u00f3n, E., Horcajada, J.P., and Catalan Infection Control and Antimicrobial Stewardship Program (VINCat-PROA) (2021). Antimicrobial consumption among 66 acute care hospitals in catalonia: Impact of the covid-19 pandemic. Antibiotics, 10.","DOI":"10.3390\/antibiotics10080943"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Grau, S., Echeverria-Esnal, D., G\u00f3mez-Zorrilla, S., Navarrete-Rouco, M.E., Masclans, J.R., Espona, M., Gracia-Arnillas, M.P., Duran, X., Comas, M., and Horcajada, J.P. (2021). Evolution of antimicrobial consumption during the first wave of COVID-19 pandemic. Antibiotics, 10.","DOI":"10.3390\/antibiotics10020132"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Elseviers, M., Wettermark, B., Almarsd\u00f3ttir, A.B., Andersen, M., Benko, R., Bennie, M., Eriksson, I., Godman, B., Krska, J., and Poluzzi, E. (2024). Drug Utilization Research: Methods and Applications, Wiley. [2nd ed.].","DOI":"10.1002\/9781119911685"},{"key":"ref_16","unstructured":"(2024, January 15). World Health Organization (WHO) [Internet]. Available online: https:\/\/www.who.int\/."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1761","DOI":"10.1556\/650.2021.32308","article-title":"A COVID-19-j\u00e1rv\u00e1ny miatt bevezetett j\u00e1rv\u00e1ny\u00fcgyi int\u00e9zked\u00e9sek hat\u00e1sa a hasi seb\u00e9szeti ell\u00e1t\u00e1sra a Bajcsy-Zsilinszky K\u00f3rh\u00e1zban","volume":"162","author":"Benedek","year":"2021","journal-title":"Orvosi Hetilap"},{"key":"ref_18","unstructured":"(2023, January 01). Nemzeti Eg\u00e9szs\u00e9gbiztos\u00edt\u00e1si Alapkezel\u0151- K\u00f3rh\u00e1zi \u00c1gysz\u00e1m- \u00e9s Betegforgalmi Kimutat\u00e1s, Available online: https:\/\/www.neak.gov.hu\/felso_menu\/szakmai_oldalak\/publikus_forgalmi_adatok\/gyogyito_megelozo_forgalmi_adat\/fekvobeteg_szakellatas_stat\/korhazi_agyszam."},{"key":"ref_19","unstructured":"(2023, August 23). Clinical Management of COVID-19: Living Guideline, [Internet]. Available online: https:\/\/www.who.int\/publications\/i\/item\/WHO-2019-nCoV-clinical-2023.2."},{"key":"ref_20","unstructured":"Miniszt\u00e9riuma, E.E., and A 2020 (2020, March 25). \u00e9vben azonos\u00edtott \u00faj koronav\u00edrus (SARS-CoV-2) okozta fert\u0151z\u00e9sek (COVID-19) megel\u0151z\u00e9s\u00e9nek \u00e9s ter\u00e1pi\u00e1j\u00e1nak k\u00e9zik\u00f6nyve. 25:2020. Available online: https:\/\/mok.hu\/public\/media\/source\/kepek\/Koronav%C3%ADrus\/Magyar%20Koronav%C3%ADrus%20K%C3%A9zik%C3%B6nyv_0328_emmi.pdf."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1622","DOI":"10.1016\/j.cmi.2020.07.016","article-title":"Bacterial co-infection and secondary infection in patients with COVID-19: A living rapid review and meta-analysis","volume":"26","author":"Langford","year":"2020","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1016\/j.jinf.2020.05.046","article-title":"Co-infections in people with COVID-19: A systematic review and meta-analysis","volume":"81","author":"Lansbury","year":"2020","journal-title":"J. Infect."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"570","DOI":"10.1016\/j.jiph.2021.02.001","article-title":"Antibiotics in treatment of COVID-19 complications: A review of frequency, indications, and efficacy","volume":"14","author":"Chedid","year":"2021","journal-title":"J. Infect. Public Health"},{"key":"ref_24","unstructured":"(2023, September 29). A Nemzeti N\u00e9peg\u00e9szs\u00e9g\u00fcgyi K\u00f6zpont t\u00e1j\u00e9koztat\u00f3ja a Nemzeti Nozokomi\u00e1lis Surveillancerendszer k\u00f6telez\u0151 moduljainak 2021. \u00e9vi eredm\u00e9nyeir\u0151l. Available online: https:\/\/www.antsz.hu\/data\/cms109485\/NNSR_jelentes_2021_1_resz_Kotelezo_surveillance_modulok.pdf."},{"key":"ref_25","unstructured":"(2022, April 21). A Nemzeti N\u00e9peg\u00e9szs\u00e9g\u00fcgyi K\u00f6zpont t\u00e1j\u00e9koztat\u00f3ja a Nemzeti Nozokomi\u00e1lis Surveillancerendszer k\u00f6telez\u0151 moduljainak 2020. \u00e9vi eredm\u00e9nyeir\u0151l. Available online: https:\/\/www.antsz.hu\/data\/cms101434\/NNSR_jelentes_2020_1._resz_kotelezo_surveillance_modulok.pdf."},{"key":"ref_26","unstructured":"(2022, April 06). A Nemzeti N\u00e9peg\u00e9szs\u00e9g\u00fcgyi K\u00f6zpont t\u00e1j\u00e9koztat\u00f3ja a Nemzeti Nozokomi\u00e1lis Surveillancerendszer k\u00f6telez\u0151 moduljainak 2019. \u00e9vi eredm\u00e9nyeir\u0151l. Available online: https:\/\/www.antsz.hu\/data\/cms101374\/NNSR_jelentes_2019_1._resz_kotelezo_surveillance_modulok.pdf."},{"key":"ref_27","unstructured":"Ecdc (2023, November 17). Antimicrobial Resistance in the EU\/EEA (EARS-Net)\u2014Annual Epidemiological Report for 2022. Available online: https:\/\/www.ecdc.europa.eu\/en\/publications-data\/surveillance-antimicrobial-resistance-europe-2022."},{"key":"ref_28","unstructured":"Ecdc (2022, November 17). Antimicrobial Resistance in the EU\/EEA (EARS-Net) AER for 2021. Available online: https:\/\/www.ecdc.europa.eu\/en\/publications-data\/surveillance-antimicrobial-resistance-europe-2021."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"683","DOI":"10.1007\/s40261-020-00933-3","article-title":"Azithromycin for COVID-19: More Than Just an Antimicrobial?","volume":"40","author":"Bleyzac","year":"2020","journal-title":"Clin. Drug Investig."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1007\/s40264-020-00976-7","article-title":"Azithromycin in COVID-19 Patients: Pharmacological Mechanism, Clinical Evidence and Prescribing Guidelines","volume":"43","author":"Sultana","year":"2020","journal-title":"Drug Saf."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1063","DOI":"10.1016\/S0140-6736(21)00461-X","article-title":"Azithromycin for community treatment of suspected COVID-19 in people at increased risk of an adverse clinical course in the UK (PRINCIPLE): A randomised, controlled, open-label, adaptive platform trial","volume":"397","author":"Butler","year":"2021","journal-title":"Lancet"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Hambalek, H., Matuz, M., Ruzsa, R., Engi, Z., Visnyovszki, \u00c1., Papfalvi, E., Hajd\u00fa, E., Dor\u00f3, P., Viola, R., and So\u00f3s, G. (2023). Impact of the COVID-19 Pandemic on Ambulatory Care Antibiotic Use in Hungary: A Population-Based Observational Study. Antibiotics, 12.","DOI":"10.3390\/antibiotics12060970"},{"key":"ref_33","unstructured":"(2023, April 27). ECDC European Centre for Disease Prevention and Control (ECDC) Antimicrobial Consumption Database (ESAC-Net). Available online: https:\/\/www.ecdc.europa.eu\/en\/antimicrobial-consumption\/surveillance-and-disease-data\/database."},{"key":"ref_34","unstructured":"(2011, October 01). Hungarian Central Statistical Office. Available online: https:\/\/www.ksh.hu\/nepesseg-es-nepmozgalom."},{"key":"ref_35","unstructured":"(2023, April 27). WHOCC\u2014ATC\/DDD Index. Available online: https:\/\/www.whocc.no\/atc_ddd_index\/?code=J01&showdescription=no."}],"container-title":["Antibiotics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-6382\/13\/1\/102\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T13:46:17Z","timestamp":1760103977000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-6382\/13\/1\/102"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1,20]]},"references-count":35,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,1]]}},"alternative-id":["antibiotics13010102"],"URL":"https:\/\/doi.org\/10.3390\/antibiotics13010102","relation":{},"ISSN":["2079-6382"],"issn-type":[{"value":"2079-6382","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,1,20]]}}}