Article Figures & Data
Figures
- Figure 1. Prescribing of azithromycin (Figure 1A) and doxycycline (Figure 1B) by month within the Research and Surveillance Centre. The 2020 prescription of both antibiotics (azithromycin = blue line, square markers; doxycycline = yellow line, square markers) was very similar in January and February to 2019 rates (azithromycin = green line, diamond markers; doxycycline = orange line; diamond markers). In March 2020, there was a peak of prescribing for both antibiotcs, coincident with the first wave of the COVID-19 pandemic. Thereafter azithromycin was prescribed in 2020 at or above the level in 2019, whereas doxycycline was prescribed less.
Azith = azithromycin. Doxy = doxycycline. Px = prescribing.
- Figure 2. Comparison of monthly incidence of consultations for lower respiratory tract infections (Figure 2A), upper respiratory tract infections (Figure 2B), and influenza-like illness (Figure 2C), comparing 2020 with 2019 in the Research and Surveillance Centre dataset. There was a lower incidence of LRTI and URI in 2020 compared with 2019, with a small peak when pupils returned to school in September 2020. ILI peaked with the first wave of the COVID-19 pandemic, and also with the return to school.
ILI = influenza-like illness. RTI = lower respiratory tract infections. URTI = upper respiratory tract infections.
- Figure 3. Monthly pattern of azithromycin (Figure 3A) and doxycycline (Figure 3B) prescription counts, for 2019 and 2020. OpenPrescribing data are only available up to October 2020.
Azith = azithromycin. Doxy = doxycycline. RCGP RSC = Royal College of General Practitioners Research and Surveillance Centre.
Tables
- Table 1. Comparison of rates of prescription of doxycycline and azithromycin in 2020 with 2019. In people aged ≥65 years there was a decrease in doxycycline use but an increase in azithromycin prescription. Lower respiratory tract infection and upper respiratory tract infection incidence fell across all age bands and both sexes. Influenza-like illness was much more similar between years.
Age, years 2019 2020 Female Male Female Male Antibiotic rates per 100000 patients (95% CI) Doxy. <16 21.74(20.4 to 23.2) 17.75(16.5 to 19.0) 19.12(17.8 to 20.5) 15.96(14.8 to 17.2) 16–64 385.28(382.1 to 388.5) 231.99(229.6 to 234.4) 380.15(377.8 to 383.3) 222.57(220.2 to 224.9) ≥65 1136.15(1126.4 to 1145.9) 1038.78(1028.6 to 1048.9) 968.28(959.3 to 977.3) 913.57(904.1 to 923.1) Azith. <16 56.89(54.6 to 59.2) 67.50(65.1 to 69.9) 53.29(51.1 to 55.5) 75.91(73.4 to 78.5) 16–64 70.02(68.7 to 71.4) 39.39(38.4 to 40.4) 70.69(69.4 to 72.1) 40.77(39.8 to 41.8) ≥65 305.17(300.1 to 310.3) 288.43(283.1 to 293.9) 339.13(333.8 to 344.5) 307.59(302.1 to 313.2) Respiratory disease rates per 100000 patients (95% CI) LRTI <16 229.25(224.67 to 233.82) 292.18(287.1 to 297.2) 68.43(65.9 to 70.9) 90.9(88.1 to 93.8) 16–64 191.30(189.1 to 193.54) 126.84(125.0 to 128.6) 81.45(79.9 to 82.9) 53.2(52.0 to 54.4) ≥65 609.27(602.05 to 616.5) 568.32(560.8 to 575.8) 267.9(263.2 to 272.8) 268.0(262.9 to 273.2) URTI <16 1320.33(1309.5 to 1331.3) 1349.86(1339.1 to 1360.7) 485.15(455.0 to 467.7) 493.1(486.6 to 499.7) 16–64 485.65(482.1 to 489.2) 229.3(226.9 to 231.8) 265.73(254.9 to 260.1) 117.38(115.7 to 119.1) ≥65 285.17(280.3 to 290.1) 208.6(204.1 to 213.2) 148.01(144.5 to 151.6) 104.61(101.4 to 107.9) ILI <16 19.30(17.1 to 19.7) 20.78(19.5 to 22.2) 16.38(15.2 to 17.7) 16.23(15.1 to 17.5) 16–64 32.57(30.8 to 32.6) 22.15(21.4 to 22.9) 37.68(36.7 to 38.7) 21.86(21.1 to 22.6) ≥65 25.40(28.2 to 31.7) 22.18(20.7 to 23.7) 29.41(27.9 to 31.0) 24.38(22.9 to 25.9) a95% confidence intervals. Azith = azithromycin. Doxy = doxycycline. ILI = influenza-like illness. LRTI = lower respiratory tract infections. URTI = upper respiratory tract infections.
- Table 2. Model reporting the incident rate ratio (IRR) comparing prescribing of azithromycin in 2020 with 2019. Taking the variables in the model into account there was a 22% increase, with people aged ≥65 years, female sex, the most deprived, northern regions and people with lower respiratory tract infections and upper respiratory tract infections all being associated with a higher rate of prescribing.
Azithromycin prescribing ratescomparing 2020 with 2019 IRR Lower Upper P 95% CI 95% CI Year 2020 (reference level: 2019) 1.22 1.19 1.26 <0.0001 Age band (reference level: 0–15) 16–64 0.71 0.68 0.73 <0.0001 ≥ 65 4.77 4.58 4.98 <0.0001 Sex (reference level: F) 0.91 0.88 0.93 <0.0001 IMD quintile (reference level: Q1, most deprived) Q2 0.90 0.86 0.94 <0.0001 Q3 0.87 0.83 0.90 <0.0001 Q4 0.75 0.72 0.78 <0.0001 Q5 (least deprived) 0.67 0.64 0.70 <0.0001 NHS region (reference: London) The Midlands and East 1.08 1.03 1.12 <0.0001 North East and Yorkshire 1.47 1.40 1.54 <0.0001 North West 1.13 1.08 1.18 <0.0001 South East 0.94 0.89 0.98 <0.0001 South West 0.72 0.69 0.76 <0.0001 Respiratory disease LRTI count 1.0051 1.0043 1.0058 <0.0001 URTI count 1.0030 1.0026 1.0035 <0.0001 ILI count 1.0017 0.9982 1.0053 0.3400 ILI = influenza-like illness. IMD = Index of Multiple Deprivation. LRTI = lower respiratory tract infections. URTI = upper respiratory tract infections.
- Table 3. Azithromycin prescribing in cases of COVID-19. For each unit rise in COVID-19 cases there has been a 3% rise in azithromycin prescriptions. Aged ≥65 years, female sex, being more deprived, northern regions, lower respiratory tract infections or influenza-like-illness infections are all associated with a higher rate of prescribing.
Azithromycin prescribing rate IRR Lower Upper P 95% CI 95% CI COVID-19 confirmed count 1.03 1.02 1.03 <0.0001 Age band (reference level: 0–15) 16–64 0.25 0.20 0.31 <0.0001 ≥65 10.95 8.67 13.83 <0.0001 Sex (reference level: F) 0.54 0.45 0.65 <0.0001 IMD quintile (reference level: Q1 most deprived) Q2 0.54 0.41 0.72 <0.0001 Q3 0.41 0.31 0.55 <0.0001 Q4 0.54 0.41 0.72 <0.0001 Q5 (least deprived) 0.66 0.50 0.88 0.0048 NHS region (reference: London) The Midlands and East 5.73 4.28 7.69 <0.0001 North East and Yorkshire 12.88 9.18 18.07 <0.0001 North West 10.31 7.34 14.49 <0.0001 South East 2.82 2.01 3.96 <0.0001 South West 1.41 1.01 1.98 0.0453 Respiratory disease LRTI count 1.94 1.92 1.97 <0.0001 URTI count 0.89 0.88 0.90 <0.0001 ILI count 1.60 1.54 1.68 <0.0001 ILI = influenza-like-illness. IMD = Index of Multiple Deprivation. LRTI = lower respiratory tract infections. URTI = upper respiratory tract infections.
Supplementary Data
- BJGPO.2021.0087_Supp.pdf -
Supplementary material is not copyedited or typeset, and is published as supplied by the author(s). The author(s) retain(s) responsibility for its accuracy.
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