key: cord-0804399-59w2klxy authors: Orubu, S. E. F.; Malik, F.; Figueras, A.; Ching, C.; Fuzail, A. M.; Wirtz, V. J.; Zaman, M. H. title: Antibacterial consumption in the context of COVID-19 in Pakistan: an analysis of national pharmaceutical sales data for 2019-20 date: 2020-12-07 journal: nan DOI: 10.1101/2020.12.05.20244657 sha: 0a4765a3e66581e2ab935f906e10bd96cc31c660 doc_id: 804399 cord_uid: 59w2klxy Objectives: Uncertainties in the pharmaceutical management of COVID-19 have led to reports of increased indiscriminate uses of antibiotics. The aim of this study was to investigate this at a national level in Pakistan. Methods: We used IQVIA pharmaceutical sales volume data to analyze antibiotic consumption for January-April 2020 in Pakistan. The consumption of 77 antibiotics for systemic use in 2020 was calculated, and compared against the same period in 2019 to track changes in total consumption and consumption pattern by six assigned therapeutic groups: tetracyclines, quinolones, beta-lactam penicillins, other-beta-lactams, macrolides and others (comprising the remaining groups). Results: The total consumption for January-April 2020 was 17.76 Defined Daily Doses per 1000 population per day (a 18.8% decrease from 2019). Quinolones, beta-lactam penicillins, other-beta-lactams, and macrolides constituted 80% of total consumption. There were increases between February-April 2020 of macrolides and others. In March 2020, 112768 more people consumed a macrolide per day compared to March 2019; mostly azithromycin. Conclusions: Total consumption decreased in the first four months of 2020 compared to 2019, possibly arising from a combination of several pre-existing and concurrent economic conditions as well as the lockdown situation. However, the results suggest an increase in the consumption of the macrolide class of antibiotics during the early phase of COVID-19 in Pakistan. Analysis: Data analysis was performed at the ATC level 3 (therapeutic groups) using two measures 89 of AbC: total consumption and consumption pattern. AbC was analysed as Defined Daily Doses 90 (DDD) per 1000 population per day, or DID (14) . For this comparative analysis, we used the 91 estimated population for 2019 of 216565318 and factored in a 2.1% growth to give the population 92 for 2020 as 221113190 (15). . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted December 7, 2020. ; https://doi.org/10.1101/2020.12.05.20244657 doi: medRxiv preprint where monthly sale amount = (Substance dosage form strength (mg/g) x unit pack-size x units 96 sold); and unit pack-size is the number of doses, or standard units, per pack. One standard unit was 97 a tablet, capsule, vial or ampoule. For oral suspensions or syrups meant for use in children, the 98 standard unit was 5 ml (17). For example, the unit pack-size for an oral liquid substance presented 99 as a 60 ml bottle was 60/5, or 12 standard units. With drops, the standard unit was adopted as 1. 123 . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted December 7, 2020. . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted December 7, 2020. ; https://doi.org/10.1101/2020.12.05.20244657 doi: medRxiv preprint compared to 42% of sales and 1.20 DID, in March 2019. Within "others" the rise was driven by 139 increase in the consumption of sulfamethoxazole-trimethoprim. coupled with COVID-19 related decrease in outpatient attendance in hospitals (18, 19) . In contrast, the rise in the consumption of macrolides in March, and, in April 2020, of "others" 151 antibiotics, may have been a result of stock-piling by medicine outlets or clients of azithromycin, 152 following its social-media promotion, alongside chloroquine and hydroxychloroquine, as a 153 preventive or treatment for COVID-19. While "others" also rose, this increase was smaller, being 154 about three orders of magnitude lower. CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted December 7, 2020. ; https://doi.org/10.1101/2020.12.05.20244657 doi: medRxiv preprint safety/toolkit_sources/en/ 219 13. Rieth M. IQVIA Quality Assurance. :137. . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted December 7, 2020. ; https://doi.org/10.1101/2020.12.05.20244657 doi: medRxiv preprint COVID-19 outbreak: current scenario of 201 New Microbes New Infect Johns Hopkins Coronavirus Resource Center Pakistan confirms first two cases of coronavirus, govt says 206 "no need to panic COVID-19 pandemic Lockdown Ended a Month Ago. Now Hospital Signs Read 'Full WHO | 7. Sources of Drug Utilization Data World Health Organization. WHO report on surveillance of antibiotic consumption: 2016-221 2018 early implementation Methods to analyse medicine utilization and expenditure to support pharmaceutical 227 policy implementation Global sales of oral antibiotics 230 formulated for children. Bull World Health Organ Pakistan's consumer sector earnings dip 26% in 2019 Recent increase in drug prices capped at 75pc Rapidly managing pneumonia in older people during a pandemic