Antibiotic consumption in Brazil: an overview of the COVID-19 pandemic era

Abstract

Background: Although antimicrobial resistance (AMR) is a natural evolutionary process, the indiscriminate and irresponsible use of antibiotics has favored the selective pressure of multidrug resistance among microorganisms. This study aimed to assess the trend in antibiotic prescription in the Brazilian population from January 2018 to December 2021, particularly during the COVID-19 pandemic. Methods: We compared hospital and community antimicrobial consumption from the National Health Surveillance Agency Database and correlated it to the microorganisms associated with healthcare-related infections. Results: The post-pandemic period showed a 26% increase in the consumption of antimicrobials in the hospital environment. The main increase was observed in the consumption of polymyxin B (137%). In 2021, 244,266 hospital-acquired infections were reported in the country. The rate of resistance to polymyxin-B was higher in 2021, mainly in Pseudomonas aeruginosa (1,400%) and Klebsiella pneumoniae (514%). On the other hand, azithromycin was the most common community-consumed antibiotic in Brazil, contributing to 24% of the total antibiotic consumption. Correlation analysis indicated a moderate to strong correlation between the increased consumption of azithromycin and COVID-19 infection. Conclusion: Our results indicate an increase in antimicrobial consumption in Brazil during the COVID-19 pandemic and reinforce the fact that the misuse of antimicrobials may lead to an increase in AMR.