Patient Characteristics Associated with Repeat Antibiotic Prescribing Pre- and during the COVID-19 Pandemic: A Retrospective Nationwide Cohort Study of >19 Million Primary Care Records Using the OpenSAFELY Platform

COVID-19 pandemic-related pressures on primary care may have driven the inappropriate continuation of antibiotic prescriptions. Yet, prescribing modality (repeat/non-repeat) has not previously been investigated in a pandemic context. With approval NHS England, we conducted retrospective cohort study >19 million English patient records using OpenSAFELY-TPP analytics platform. We analysed repeat/non-repeat frequency monthly cohorts between January 2020 and 2022. In-depth analysis was (“pre-pandemic”) 2021 (“pandemic”) (with particular focus repeat prescribing). Per-patient clinical conditions were determined by searching codelists. Prescriptions 6-month lookback period used to delineate (≥3 prescriptions) non-repeat (1–2 prescriptions). Associations demographics (e.g., age, sex, ethnicity) explored unadjusted risk ratios. The among prescribed patients examined. Antibiotic declined from May 2020; more strongly than (maximum declines −26% vs. −11%, respectively). Older at higher (especially Comorbidities common repeat- non-repeat-prescribed patients. In cohort, most linked COPD comorbidity urinary tract infection. Our findings inform ongoing development stewardship interventions targeting groups wherein there is high prevalence prescribing.