The total sales of antibiotics increased greatly in March 2020, while the sales of antibiotics on prescription did not increase. This can be interpreted as reflecting high procurement by hospitals/institutions in the first weeks of the pandemic in an attempt to step up their preparedness in a situation of uncertainty. In the following months, the use of antibiotics fell steeply. Similar changes have been found also in Sweden and Denmark (7, 8). Internationally, an increased use of broad-spectrum antibiotics has been reported in hospitals during the pandemic (9), but we were unable to find any studies from the primary health service. At an early stage of the pandemic it was suggested to treat COVID-19 patients with azithromycin in combination with hydroxychloroquine. In Norway, such use was advised against. On 3 April, the Norwegian Directorate of Health recommended that the national guidelines be followed (10).
The significant reduction may have two main causes. First, it seems as though the powerful infection control measures have also reduced the number of infections that otherwise would have been treated with antibiotics. This is consistent with the observation that the number of hospitalisations for infections has also fallen during the pandemic (11). Second, the threshold to visit a prescribing doctor has been raised during the pandemic. In practice, many GPs' surgeries have been closed to patients with fever and/or symptoms of a respiratory infection, who instead have been referred to separate respiratory clinics or dealt with by way of e-consultations as needed. In April 2020, the number of consultations resulting in respiratory infection diagnoses (except COVID-19) in the primary health service was 34 % lower than in April 2019, and the figure has remained low (12). It appears as though patients have tended to wait out the infection at home – or alternatively had themselves tested for COVID-19 – instead of seeking out their GP. It is reasonable to imagine that whereas prior to the pandemic, people would have been more concerned whether a respiratory infection should be treated with antibiotics, during the pandemic this has been replaced by a need to check whether the infection is due to SARS-CoV-2.
In recent years, a number of measures have been taken to achieve more correct and less frequent use of antibiotics, both in the primary and the specialist health services. In 2019, it did not appear that we would achieve the target of a 30 % reduction from 2012 to 2020. With the COVID-19 pandemic, however, the target seems to have been achieved: from 2012 to 2020, the use has been reduced by 32 %. Strict infection control measures and a ban on visiting your GP for a respiratory infection cannot be justified by a possible reduction in the use of antibiotics. Nevertheless we can draw a lesson from this – an already limited use of antibiotics can be further reduced.