We describe the trend of
antibiotic prescribing in out-of-hours (OOH) general practices (GP) before and during England's first wave of the
COVID-19 pandemic. We analysed practice-level prescribing records between January 2016 to June 2020 to report the trends for the total prescribing volume, prescribing of broad-spectrum
antibiotics and key agents included in the national Quality Premium. We performed a time-series analysis to detect measurable changes in the prescribing volume associated with
COVID-19. Before
COVID-19, the total prescribing volume and the percentage of broad-spectrum
antibiotics continued to decrease in-hours (IH). The prescribing of broad-spectrum
antibiotics was higher in OOH (OOH: 10.1%, IH: 8.7%), but a consistent decrease in the
trimethoprim-to-
nitrofurantoin ratio was observed OOH. The OOH
antibiotic prescribing volume diverged from the historical trend in March 2020 and started to decrease by 5088 items per month. Broad-spectrum
antibiotic prescribing started to increase in OOH and IH. In OOH,
co-amoxiclav and
doxycycline peaked in March to May in 2020, which was out of sync with seasonality peaks (Winter) in previous years. While this increase might be explained by the implementation of the national guideline to use
co-amoxiclav and
doxycycline to manage
pneumonia in the community during
COVID-19, further investigation is required to see whether the observed reduction in OOH
antibiotic prescribing persists and how this reduction might influence antimicrobial resistance and patient outcomes.