Abstract: The aims of this study were to analyze the utilization of antibiotics before (2018, 2019)
and during the COVID-19 pandemic (2020) and the practice of prescribing antibiotics in outpatient
settings for COVID-19 patients during the 2020–2022 period. The Anatomical Therapeutic Chemical
Classification/Defined Daily Dose methodology was used for the analysis of outpatient antibiotic
utilization in the Republic of Srpska. The data was expressed in DDD/1000 inhabitants/day. The
rate of antibiotics prescribed to COVID-19 outpatients was analyzed using medical record data from
16,565 patients registered with B34.2, U07.1, and U07.2 World Health Organization International
Classification of Diseases 10th revision codes. During 2020, outpatient antibiotic utilization increased
by 53.80% compared to 2019. At least one antibiotic was prescribed for 91.04%, 83.05%, and 73.52% of
COVID-19 outpatients during 2020, 2021, and the first half of 2022, respectively. On a monthly basis,
at least one antibiotic was prescribed for more than 55% of COVID-19 outpatients. The three most
commonly prescribed antibiotics were azithromycin, amoxicillin/clavulanic acid, and doxycycline.
The trend of repurposing antibiotics for COVID-19 and other diseases treatment might be a doubleedged sword. The long-term effect of this practice might be an increase in antimicrobial resistance
and a loss of antibiotic effectiveness.
