Background No national study has evaluated changes in the appropriateness of US outpatient antibiotic prescribing across all conditions and age groups after the coronavirus disease 2019 (COVID-19) outbreak in March 2020. Methods This was an interrupted time series analysis of Optum's de-identified Clinformatics Data Mart Database, a national commercial and Medicare Advantage claims database. Analyses included prescriptions for antibiotics dispensed to children and adults enrolled during each month during 2017–2021. For each prescription, we applied our previously developed antibiotic appropriateness classification scheme to International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis codes on medical claims occurring on or during the 3 days prior to dispensing. Outcomes included the monthly proportion of antibiotic prescriptions that were inappropriate and the monthly proportion of enrollees with ≥1 inappropriate prescription. Using segmented regression models, we assessed for level and slope changes in outcomes in March 2020. Results Analyses included 37 566 581 enrollees, of whom 19 154 059 (51.0%) were female. The proportion of enrollees with ≥1 inappropriate prescription decreased in March 2020 (level decrease: −0.80 percentage points [95% confidence interval {CI}, −1.09% to −.51%]) and subsequently increased (slope increase: 0.02 percentage points per month [95% CI, .01%–.03%]), partly because overall antibiotic dispensing rebounded and partly because the proportion of antibiotic prescriptions that were inappropriate increased (slope increase: 0.11 percentage points per month [95% CI, .04%–.18%]). In December 2021, the proportion of enrollees with ≥1 inappropriate prescription equaled the corresponding proportion in December 2019. Conclusions Despite an initial decline, the proportion of enrollees exposed to inappropriate antibiotics returned to baseline levels by December 2021. Findings underscore the continued importance of outpatient antibiotic stewardship initiatives.

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2019 年冠状病毒病爆发后美国门诊抗生素处方适当性的变化：2016-2021 年数据的间断时间序列分析

背景 2020 年 3 月 2019 年冠状病毒病 (COVID-19) 爆发后，尚无全国性研究评估美国门诊抗生素处方在所有病症和年龄组中的适当性变化。方法这是对 Optum 的去识别化临床信息学进行的中断时间序列分析数据集市数据库，国家商业和 Medicare Advantage 索赔数据库。分析包括 2017 年至 2021 年每个月向登记的儿童和成人发放的抗生素处方。对于每个处方，我们将之前开发的抗生素适当性分类方案应用于配药前 3 天或期间发生的医疗索赔的国际疾病分类第十修订版临床修改诊断代码。结果包括每月不适当的抗生素处方比例以及每月使用 ≥1 种不适当处方的参与者比例。我们使用分段回归模型评估了 2020 年 3 月结果的水平和斜率变化。结果分析包括 37 566 581 名参与者，其中 19 154 059 名 (51.0%) 为女性。 2020 年 3 月，拥有 ≥1 个不适当处方的登记者比例有所下降（水平下降：-0.80 个百分点 [95% 置信区间 {CI}，-1.09% 至 -.51%]），随后有所增加（斜率增加：0.02 个百分点）每月 [95% CI, .01%–.03%]），部分是因为总体抗生素配药量反弹，部分是因为不适当的抗生素处方比例增加（斜率增加：每月 0.11 个百分点 [95% CI, .03%]）。 04%–.18%]）。 2021 年 12 月，持有 ≥1 种不适当处方的登记者比例与 2019 年 12 月的相应比例持平。结论 尽管最初有所下降，但到 2021 年 12 月，接触不适当抗生素的登记者比例已恢复至基线水平。研究结果强调了门诊治疗的持续重要性抗生素管理举措。