A national study analyzing over 600,000 hospital admissions across 803 U.S. hospitals from 2019 to 2023 reveals that while antibiotic use among hospitalized patients with COVID-19 and other viral acute respiratory tract infections (ARTIs) has declined since the pandemic’s onset, unnecessary prescribing remains prevalent.
Published in Open Forum Infectious Diseases by researchers from the University of Wisconsin School of Medicine and Public Health and University of Massachusetts Chan Medical School – Baystate, the study highlights that over 80% of COVID-19 patients received antibiotics in March 2020, despite low rates of confirmed bacterial coinfections. By May 2022, this rate dropped to just over 30%, stabilizing around 35% through 2023. For patients with other ARTIs like influenza and RSV, antibiotic prescribing peaked at 68%, later returning to seasonal averages near 50%.
Disease severity was a major driver of prescribing, with more antibiotics given in ICU and intermediate care settings than inpatient wards. Overall, prescribing declined over time in all levels of care, but COVID-19 patients were significantly less likely than other viral ARTI patients to receive antibiotics after adjusting for clinical factors.
“These findings reflect how early uncertainty and limited treatment options fueled antibiotic use,” said lead author Dr. Michael Pulia, associate professor of emergency medicine at UW and director of its Emergency Care for Infectious Diseases research program. “But even in 2023, nearly half of viral ARTIs were treated with antibiotics, raising ongoing concerns about resistance, side effects, and care quality.”
The authors stress that judicious prescribing remains essential as antibiotic resistance grows, calling for better diagnostic tools and stronger antimicrobial stewardship programs — especially during public health emergencies.
This project was funded under grant number R01 HS028669 from the Agency for Healthcare Research and Quality (AHRQ), U.S. Department of Health and Human Services.