PRINCIPLE trial demonstrates scope for in-pandemic improvement in primary care antibiotic stewardship: a retrospective sentinel network cohort study
| Autor: | Mark Joy, Simon de Lusignan, Kome Gbinigie, Christopher C Butler, Julian Sherlock, Fd Richard Hobbs, Oliver van Hecke, Manasa Tripathy, John H. H. Williams |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Medicine (General) Respiratory tract infections business.industry Research Incidence (epidemiology) Absolute risk reduction clinical trial pandemics Azithromycin Confidence interval primary health care antimicrobial stewardship R5-920 covid-19 Internal medicine medical records systems computerized medicine Antimicrobial stewardship Medical prescription Family Practice business Cohort study medicine.drug |
| Zdroj: | BJGP Open, Vol 5, Iss 5 (2021) BJGP Open |
| ISSN: | 2398-3795 |
| Popis: | BackgroundThe 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).AimTo explore the extent of in-pandemic azithromycin and doxycycline use, and the scope for trial findings impacting on practice.Design & settingCrude 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).MethodNegative 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).ResultsAzithromycin 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; PPConclusionPRINCIPLE demonstrates scope for improved antimicrobial stewardship during a pandemic. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|