Octavia Sabin 1* , Ionela Madalina Parauan 1, Alexandru Constantin Sirbu 1
1 Department of Pharmacology, Toxicology and Clinical Pharmacology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
* Correspondence to: Octavia Sabin, Department of Pharmacology, Toxicology and Clinical Pharmacology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania; Address: 23 Ghe Marinescu str., 2nd floor Cluj-Napoca, Romania. Phone: +40740191078; E-mail: octavia.sabin@umfcluj.ro
Abstract
The COVID-19 pandemic led to widespread antibiotic use despite limited evidence supporting their effectiveness against viral infections. In Romania, national treatment protocols evolved to reflect emerging data, particularly discouraging antibiotics in the absence of bacterial infection. This study evaluates how prescribers adapted their antibiotic prescribing after a major revision of Romania’s COVID-19 treatment protocol. It also examines anti-biotic use based on the WHO AWaRe classification and potential effects on Clostridioides difficile infection (CDI) incidence. This retrospective study analyzed non-ICU adult COVID-19 patients admitted to a support hospital in Cluj-Napoca, Romania, from November 2020 to May 2021. Data from electronic hospital records included antibi-otic prescriptions, bacterial infection diagnoses, and CDI occurrence. Antibiotic prescribing patterns were compared before and after the protocol revision on December 15, 2020. Among 298 patients, 75.5% had not received anti-biotics before admission, yet 85.9% received them in-hospital. Following the protocol change, in-hospital antibiotic use significantly decreased (p=0.02), especially in moderate COVID-19 cases (p=0.003), though pre-hospital use remained unchanged. The most prescribed antibiotics belonged to the WHO “Watch” category. CDI was diag-nosed in 8.38% of patients, with no significant link to antibiotic use (p=0.36). While the protocol revision reduced in-hospital antibiotic prescribing, outpatient use remained high, emphasizing the need for stronger antimicrobial stewardship. Continued efforts are essential to optimize antibiotic use and curb antimicrobial resistance, particularly in settings with high antibiotic consumption.