Late delivery of antibiotics: A new proxy for antimicrobial stewardship ?

OBJECTIVES:To analyze the time elapsed between prescription of antibiotics and their pick-up at the pharmacy, and identify their determinants. METHODS:We used the National Health Insurance reimbursement databases on antibiotics delivery in 2021 in La Manche, western France. Delayed delivery was defined as time between prescription and antibiotic pick-up >24 h. RESULTS:We enrolled 207,250 prescriptions, of whom 18,728 (9.0%) collected their antibiotics at the community pharmacy >24 h after prescription. Independent factors associated with delayed delivery were age >15 years (15-64 years: OR 2.08 [1.98-2.19], p<0.001; >65 years OR 3.27 [3.09-3.46], p<0.001), male sex (OR 00.77 [0.75-0.80], p<0.001), low-income (OR 1.08 [1.02-1.15], p=0.013), chronic diseases (OR 1.29 [1.25-1.34], p<0.001), prescription during the week-end (OR 1.49 [1.43-1.56], p<0.001), summer season (OR 1.11 [1.07-1.16], p<0.001) lock-down period (OR 4.15 [3.80-4.53], p<0.001) and distance from patient home to his GP office and the pharmacy >10 km (OR 1.17 [1.13-1.21], p<0.001). CONCLUSIONS:Delayed delivery of antibiotics after prescription is not uncommon, especially in elderly patients, those with low income or chronic diseases, in case of week-end prescriptions, summer season and when the pharmacy is >10 km away from patient home and his GP office. If confirmed, this potential indicator of unnecessary prescriptions, readily available in some databases, may be used to target antimicrobial stewardship programs, and monitor the impact of interventions.