TY - JOUR T1 - PRINCIPLE trial demonstrates scope for in-pandemic improvement in primary care antibiotic stewardship: a retrospective sentinel network cohort study JF - BJGP Open JO - BJGP Open DO - 10.3399/BJGPO.2021.0087 VL - 5 IS - 5 SP - BJGPO.2021.0087 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 Y1 - 2021/10/01 UR - http://bjgpopen.org/content/5/5/BJGPO.2021.0087.abstract N2 - 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. ER -