Antimicrobial stewardship challenges during the COVID-19 pandemic: implications of antibiotic overuse and antimicrobial resistance

Abstract

The coronavirus disease 2019 (COVID-19) pandemic significantly influenced antimicrobial prescribing practices worldwide, raising concerns about antimicrobial resistance (AMR). This narrative review assesses the relationship between COVID-19 and antibiotic use, focusing on bacterial co-infections, prescribing patterns, long-term implications for AMR, and the role of multidisciplinary antimicrobial and diagnostic stewardship, preventive strategies, and the One Health approach in reducing disproportionate antibiotic exposure. To this end we ran a subject search across PubMed/MEDLINE, Scopus, Web of Science, the Cochrane Database of Systematic Reviews, Ovid, and Google Scholar for studies selected according to predefined inclusion and exclusion criteria. Despite relatively low rates of confirmed bacterial co-infections, antibiotic use remained disproportionately high, particularly during the early stages of the pandemic, highlighting challenges in clinical decision-making under diagnostic uncertainty. Excessive and inappropriate antibiotic prescribing may have contributed to the global AMR burden. Strengthening antimicrobial stewardship programmes, improving diagnostic accuracy and promoting evidence-based prescribing are therefore essential. Multidisciplinary antimicrobial stewardship interventions, rapid molecular diagnostics and vaccination-associated reductions in antibiotic prescribing emerge as complementary strategies for limiting unnecessary antimicrobial exposure, while the environmental consequences of antibiotic use further emphasise the relevance of the One Health approach. Continued surveillance and research are needed to better understand the long-term impact of the pandemic on AMR.