PT - JOURNAL ARTICLE AU - Simon de Lusignan AU - Mark Joy AU - Julian Sherlock AU - Manasa Tripathy AU - Oliver van Hecke AU - Kome Gbinigie AU - John Williams AU - Christopher Butler AU - FD Richard Hobbs TI - PRINCIPLE trial demonstrates scope for in-pandemic improvement in primary care antibiotic stewardship: a retrospective sentinel network cohort study AID - 10.3399/BJGPO.2021.0087 DP - 2021 Jul 22 TA - BJGP Open PG - BJGPO.2021.0087 4099 - http://bjgpopen.org/content/early/2021/07/26/BJGPO.2021.0087.short 4100 - http://bjgpopen.org/content/early/2021/07/26/BJGPO.2021.0087.full AB - 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 COVID-19.Aim To explore the extent of azithromycin and doxycycline in-pandemic 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 A negative binomial model was used to compare azithromycin and doxycycline 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 of 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.