Antibiotic Utilisation Patterns in Tanzania: A Retrospective Longitudinal Study Comparing Pre- and Post-COVID-19 Pandemic Using Tanzania Medicines and Medical Devices Authority Data

Background: Antimicrobial resistance (AMR) is a growing public health concern globally, and misuse of antibiotics is a major contributor. Objective: This study investigated antibiotic utilisation patterns before and after the COVID-19 pandemic in Tanzania using data from the Tanzania Medicines and Medical Devices Authority (TMDA). Methods: This retrospective longitudinal study analysed secondary data. The study compared antibiotics consumption in defined daily doses (DDD) per 1000 inhabitants per day (DID) in two distinct eras: 2018-2019 as the pre-COVID-19 era and 2020-2021 as the post-COVID-19 era. Data was reorganised using Microsoft Power BI, and statistical analysis was conducted using SPSS software. Results: The study analysed 10,614 records and found an overall increase in antibiotics consumption from 2018 to 2021. When we divided the consumption of antibiotics into a pre- and post-COVID time period, with the pre-COVID period being 2018 and 2019 and the post-COVID period being 2020 and 2021, we found that the consumption was 61.24 DID in the post-COVID era and 50.32 DID in the pre-COVID era. Levofloxacin had the highest percentage increase in use, with a 700% increase in DID after the pandemic. Azithromycin had a 163.79% increase, while cefotaxime had a 600% increase. In contrast, some antibiotics exhibited a decrease in usage after the pandemic, such as nalidixic acid, which had a 100% decrease, and cefpodoxime, 66.67% decrease. Conclusion: The increase in antibiotic consumption during the COVID-19 pandemic highlights the importance of implementing effective antimicrobial stewardship strategies to prevent AMR, especially during pandemics. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study did not receive any funding. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present work are contained in the manuscript