PRINCIPLE trial demonstrates scope for in-pandemic improvement in primary care antibiotic stewardship: a retrospective sentinel network cohort study

Simon de Lusignan; Mark Joy; Julian Sherlock; Manasa Tripathy; Oliver van Hecke; Kome Gbinigie; John Williams; Christopher Butler; FD Richard Hobbs

doi:10.3399/BJGPO.2021.0087

BJGP Open (Oct 2021)

PRINCIPLE trial demonstrates scope for in-pandemic improvement in primary care antibiotic stewardship: a retrospective sentinel network cohort study

Simon de Lusignan,
Mark Joy,
Julian Sherlock,
Manasa Tripathy,
Oliver van Hecke,
Kome Gbinigie,
John Williams,
Christopher Butler,
FD Richard Hobbs

Affiliations

Simon de Lusignan: Professor of Primary Care & Clinical Informatics, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
Mark Joy: Senior Researcher, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
Julian Sherlock: SQL Developer, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
Manasa Tripathy: Research Officer/Practice Liaison Officer, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
Oliver van Hecke: NIHR Academic Clinical Lecturer, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
Kome Gbinigie: GP and DPhil Student, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
John Williams: Senior Research Fellow, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
Christopher Butler: Professor of Primary Care, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
FD Richard Hobbs: Head of Department, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK

DOI: https://doi.org/10.3399/BJGPO.2021.0087
Journal volume & issue: Vol. 5, no. 5

Abstract

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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.

Published in BJGP Open

ISSN: 2398-3795 (Online)
Publisher: Royal College of General Practitioners
Country of publisher: United Kingdom
LCC subjects: Medicine: Medicine (General)
Website: https://bjgpopen.org/

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