RT Journal Article SR Electronic 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 FD Royal College of General Practitioners SP BJGPO.2021.0087 DO 10.3399/BJGPO.2021.0087 VO 5 IS 5 A1 Simon de Lusignan A1 Mark Joy A1 Julian Sherlock A1 Manasa Tripathy A1 Oliver van Hecke A1 Kome Gbinigie A1 John Williams A1 Christopher Butler A1 FD Richard Hobbs YR 2021 UL http://bjgpopen.org/content/5/5/BJGPO.2021.0087.abstract 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 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.