Seasonal variations and the COVID-19 pandemic: impact on antimicrobial stewardship and antibiotic prescribing in a UK secondary care setting to combat antimicrobial resistance—a pilot study

Antimicrobial resistance (AMR) remains a major global health challenge, amplified by inappropriate antibiotic use during public health crises such as the COVID-19 pandemic. This pilot study, published in Frontiers in Microbiology, explores the combined impact of seasonal variation and pandemic conditions on antimicrobial stewardship (AMS) interventions in two NHS hospitals in the UK.

Using interrupted time-series analysis, we reviewed 80 patient records with respiratory tract infections (RTIs) across four seasonal periods in 2019 and 2020. AMS practices were assessed using the UKHSA’s Start Smart, Then Focus framework, through the CARES model—Cease, Amend, Refer, Extend, and Switch.

Notable shifts included a rise in “Cease” actions from 5% in winter 2019 to 9% in spring 2020 and a peak in “Switch” interventions at 6%—reflecting a dynamic response to the pressures of the pandemic. CAP was the most common diagnosis, with clear seasonal peaks.

While limited in scale, the study highlights the value of pilot testing in evaluating AMS feasibility and reliability, and advocates for the development of robust, sustainable AMS frameworks that are responsive to both seasonal pressures and global health emergencies.