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Sales of antibiotics and hydroxychloroquine in India during the COVID-19 epidemic: An interrupted time series analysis

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  • Giorgia Sulis
  • Brice Batomen
  • Anita Kotwani
  • Madhukar Pai
  • Sumanth Gandra

Abstract

Background: We assessed the impact of the coronavirus disease 2019 (COVID-19) epidemic in India on the consumption of antibiotics and hydroxychloroquine (HCQ) in the private sector in 2020 compared to the expected level of use had the epidemic not occurred. Methods and findings: We performed interrupted time series (ITS) analyses of sales volumes reported in standard units (i.e., doses), collected at regular monthly intervals from January 2018 to December 2020 and obtained from IQVIA, India. As children are less prone to develop symptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, we hypothesized a predominant increase in non-child-appropriate formulation (non-CAF) sales. COVID-19-attributable changes in the level and trend of monthly sales of total antibiotics, azithromycin, and HCQ were estimated, accounting for seasonality and lockdown period where appropriate. A total of 16,290 million doses of antibiotics were sold in India in 2020, which is slightly less than the amount in 2018 and 2019. However, the proportion of non-CAF antibiotics increased from 72.5% (95% CI: 71.8% to 73.1%) in 2019 to 76.8% (95% CI: 76.2% to 77.5%) in 2020. Our ITS analyses estimated that COVID-19 likely contributed to 216.4 million (95% CI: 68.0 to 364.8 million; P = 0.008) excess doses of non-CAF antibiotics and 38.0 million (95% CI: 26.4 to 49.2 million; P

Suggested Citation

  • Giorgia Sulis & Brice Batomen & Anita Kotwani & Madhukar Pai & Sumanth Gandra, 2021. "Sales of antibiotics and hydroxychloroquine in India during the COVID-19 epidemic: An interrupted time series analysis," PLOS Medicine, Public Library of Science, vol. 18(7), pages 1-18, July.
    • Handle: RePEc:plo:pmed00:1003682
    DOI: 10.1371/journal.pmed.1003682
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    1. Giorgia Sulis & Pierrick Adam & Vaidehi Nafade & Genevieve Gore & Benjamin Daniels & Amrita Daftary & Jishnu Das & Sumanth Gandra & Madhukar Pai, 2020. "Antibiotic prescription practices in primary care in low- and middle-income countries: A systematic review and meta-analysis," PLOS Medicine, Public Library of Science, vol. 17(6), pages 1-20, June.
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