<jats:title>Abstract</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>The Platform Randomised trial of INterventions against COVID-19 In older peoPLE (PRINCIPLE) trial has provided in-pandemic evidence of what does not work in the early primary care management of coronavirus-2019 disease (COVID-19). PRINCIPLE’s first finding was that azithromycin and doxycycline were not effective.</jats:p></jats:sec><jats:sec><jats:title>Aim</jats:title><jats:p>To explore the extent to which azithromycin and doxycycline were being used in-pandemic, and the scope for trial findings impacting on practice.</jats:p></jats:sec><jats:sec><jats:title>Design and Setting</jats:title><jats:p>We compared crude rates of prescribing and respiratory tract infections (RTI) in 2020, the pandemic year, with 2019, using the Oxford-Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC).</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>We used a negative binomial model including age-band, gender, socioeconomic status, and NHS region 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).</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Azithromycin prescriptions increased 7% in 2020 compared to 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 by 42.1% between 2019 and 2020, doxycycline increased by 33%.</jats:p><jats:p>Our adjusted IRR showed azithromycin prescribing was 22% higher in 2020 (IRR=1.22, 95%CI:1.19-1.26, p&lt;0.0001), for every unit rise in confirmed COVID there was an associated 3% rise in prescription (IRR=1.026, 95%CI 1.024-1.0285, p&lt;0.0001); whereas these measures were static for doxycycline.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>PRINCIPLE trial flags scope for improvement in antimicrobial stewardship.</jats:p></jats:sec>

Original publication




Journal article


Cold Spring Harbor Laboratory

Publication Date