Background/Objectives: Improper use of systemic antibiotics remains a significant
concern in hospital settings, contributing to increased antimicrobial resistance
and suboptimal clinical outcomes. The COVID-19 pandemic exacerbated this issue. This
study aimed to evaluate long-term trends in antibiotic utilization in low-resource settings
at a tertiary care teaching hospital, focusing specifically on the changes before, during,
and after the COVID-19 pandemic. Methods: This retrospective observational study
analyzed antibiotic utilization data from the University Clinical Centre of the Republic
of Srpska over ten years (2015–2024). Antibiotic consumption was expressed in defined
daily doses (DDD) per 100 bed-days, and compared across three periods: pre-COVID-19
(2015–2019), COVID-19 (2020–2022), and post-COVID-19 (2023–2024). Additionally, antibiotic
use was categorized according to the WHO AWaRe classification. Results: Antibiotic
utilization peaked during the COVID-19 period, with the highest rate observed in 2021
(91.5 DDD/100 bed-days), despite a decrease in hospital admissions. The most frequently
used antibiotics were cephalosporins, penicillins, and metronidazole. A significant increase
in the use of azithromycin, meropenem, piperacillin/tazobactam, vancomycin, and colistin
was noted during the COVID-19 and post-COVID-19 periods (p < 0.05), along with a notable
decline in penicillin use. Watch and Reserve antibiotic use rose significantly (p < 0.05),
while Access group use fell from 67% to 49.2%. Conclusions: These findings underscore
the lasting impact of the COVID-19 pandemic on antibiotic prescribing patterns and emphasize
the urgent need for strengthened antimicrobial stewardship efforts to ensure rational
antibiotic use and combat antimicrobial resistance.
