The impact of influenza and pneumococcal vaccination on antibiotic use: an updated systematic review and meta-analysis.

Publication date: Jul 14, 2023

Vaccination can prevent bacterial and viral infections that could otherwise increase the chances of receiving (unnecessary) antibiotic treatment(s). As a result, vaccination may provide an important public health intervention to control antimicrobial resistance (AMR). Perform a systematic literature review to better understand the impact of influenza, pneumococcal and COVID-19 vaccination on antibiotic use, and to identify differences in effect between world regions and study designs. We performed a systematic literature review and meta-analysis which updated previous literature reviews with new data from 1 October 2018 to 1 December 2021. The study focuses on randomised controlled trials (RCTs) and observational studies. Results from the meta-analysis of RCTs were stratified by WHO region and age group. Vote counting based on the direction of effect was applied to synthesize the results of the observational studies. Most studies are performed in the WHO European Region and the Region of the Americas in high-income countries. RCTs show that the effect of influenza vaccination on the number of antibiotic prescriptions or days of antibiotic use (Ratio of Means (RoM) 0. 71, 95% CI 0. 62-0. 83) is stronger compared to the effect of pneumococcal vaccination (RoM 0. 92, 95% CI 0. 85-1. 00). These studies also confirm a reduction in the proportion of people receiving antibiotics after influenza vaccination (Risk Ratio (RR) 0. 63, 95% CI 0. 51-0. 79). The effect of influenza vaccination in the European and American regions ranged from RoM 0. 63 and 0. 87 to RR 0. 70 and 0. 66, respectively. The evidence from observational studies supports these findings but presents a less consistent picture. No COVID-19 studies were identified. We find that both RCTs and observational studies show that influenza vaccination significantly reduces antibiotic use, while the effect of pneumococcal vaccination is less pronounced. We were unable to study the effect of COVID-19 vaccination and no clear regional patterns were found due to the high heterogeneity between studies. Overall, our data supports the use of influenza vaccination as an important public health intervention to reduce antibiotic use and possibly control AMR.

Concepts Keywords
Americas Antibiotic prescriptions
Antibiotics Antibiotic use
December Antimicrobial resistance
Influenza Influenza
Vote Pneumococcal disease
Systematic literature review


Type Source Name
disease MESH influenza
disease VO vaccination
disease MESH viral infections
disease IDO intervention
drug DRUGBANK Tropicamide
disease MESH COVID-19
disease MESH Pneumococcal disease

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