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PRINCIPLE trial demonstrates scope for in-pandemic improvement in primary care antibiotic stewardship: a retrospective sentinel network cohort study.
de Lusignan, Simon; Joy, Mark; Sherlock, Julian; Tripathy, Manasa; van Hecke, Oliver; Gbinigie, Kome; Williams, John; Butler, Christopher; Hobbs, Fd Richard.
  • de Lusignan S; Professor of Primary Care & Clinical Informatics, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK simon.delusignan@phc.ox.ac.uk.
  • Joy M; Senior Researcher, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
  • Sherlock J; SQL Developer, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
  • Tripathy M; Research Officer/Practice Liaison Officer, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
  • van Hecke O; NIHR Academic Clinical Lecturer, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
  • Gbinigie K; GP and DPhil Student, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
  • Williams J; Senior Research Fellow, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
  • Butler C; Professor of Primary Care, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
  • Hobbs FR; Head of Department, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK richard.hobbs@phc.ox.ac.uk.
BJGP Open ; 5(5)2021 Oct.
Article in English | MEDLINE | ID: covidwho-1328146
ABSTRACT

BACKGROUND:

The Platform Randomised trial of INterventions against COVID-19 In older peoPLE (PRINCIPLE) has provided in-pandemic evidence that azithromycin and doxycycline were not beneficial in the early primary care management of coronavirus 2019 disease (COVID-19).

AIM:

To explore the extent of in-pandemic azithromycin and doxycycline use, and the scope for trial findings impacting on practice. DESIGN &

SETTING:

Crude rates of prescribing and respiratory tract infections (RTI) in 2020 were compared with 2019, using the Oxford Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC).

METHOD:

Negative binomial models were used to compare azithromycin and doxycycline prescribing, lower respiratory tract infections (LRTI), upper respiratory tract infections (URTI), and influenza-like illness (ILI) in 2020 with 2019; reporting incident rate ratios (IRR) between years, and 95% confidence intervals (95% CI).

RESULTS:

Azithromycin prescriptions increased 7% in 2020 compared with 2019, whereas doxycycline decreased by 7%. Concurrently, LRTI and URTI incidence fell by over half (58.3% and 54.4%, respectively) while ILI rose slightly (6.4%). The overall percentage of RTI-prescribed azithromycin rose from 0.51% in 2019 to 0.72% in 2020 (risk difference 0.214%; 95% CI = 0.211 to 0.217); doxycycline rose from 11.86% in 2019 to 15.79% in 2020 (risk difference 3.93%; 95% CI = 3.73 to 4.14). The adjusted IRR showed azithromycin prescribing was 22% higher in 2020 (IRR = 1.22; 95% CI = 1.19 to 1.26; P<0.0001). For every unit rise in confirmed COVID-19 there was an associated 3% rise in prescription (IRR = 1.03; 95% CI = 1.02 to 1.03; P<0.0001); whereas these measures were static for doxycycline.

CONCLUSION:

PRINCIPLE demonstrates scope for improved antimicrobial stewardship during a pandemic.
Keywords

Full text: Available Collection: International databases Database: MEDLINE Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Language: English Year: 2021 Document Type: Article Affiliation country: BJGPO.2021.0087

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Language: English Year: 2021 Document Type: Article Affiliation country: BJGPO.2021.0087