scholarly journals PRINCIPLE trial demonstrates scope for in-pandemic improvement in primary care antibiotic stewardship

2021 ◽  
Author(s):  
Simon de Lusignan ◽  
Mark Joy ◽  
Julian Sherlock ◽  
Manasa Tripathy ◽  
Oliver van Hecke ◽  
...  
Keyword(s):  
Primary Care ◽  
Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Negative Binomial ◽  
Randomised Trial ◽  
Upper Respiratory Tract ◽  
Incident Rate ◽  
Early Primary ◽  
Rate Ratios ◽  
Tract Infections

AbstractBackgroundThe 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.AimTo explore the extent to which azithromycin and doxycycline were being used in-pandemic, and the scope for trial findings impacting on practice.Design and SettingWe 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).MethodsWe 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).ResultsAzithromycin 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%.Our adjusted IRR showed azithromycin prescribing was 22% higher in 2020 (IRR=1.22, 95%CI:1.19-1.26, p<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<0.0001); whereas these measures were static for doxycycline.ConclusionPRINCIPLE trial flags scope for improvement in antimicrobial stewardship.

scholarly journals PRINCIPLE trial demonstrates scope for in-pandemic improvement in primary care antibiotic stewardship: a retrospective sentinel network cohort study

BJGP Open ◽  
2021 ◽  
pp. BJGPO.2021.0087
Author(s):  
Simon de Lusignan ◽  
Mark Joy ◽  
Julian Sherlock ◽  
Manasa Tripathy ◽  
Oliver van Hecke ◽  
...  
Keyword(s):  
Primary Care ◽  
Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Negative Binomial ◽  
Randomised Trial ◽  
Risk Difference ◽  
Upper Respiratory Tract ◽  
Sentinel Network ◽  
Rate Ratios ◽  
Tract Infections

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 COVID-19.AimTo explore the extent of azithromycin and doxycycline in-pandemic 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).MethodA 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).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 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.ConclusionPRINCIPLE demonstrates scope for improved antimicrobial stewardship during a pandemic.

scholarly journals Treatment of Upper Respiratory Tract Infections in Primary Care: A Randomized Study Using Aromatic Herbs

2011 ◽  
Vol 2011 ◽  
pp. 1-7 ◽  
Author(s):  
Eran Ben-Arye ◽  
Nativ Dudai ◽  
Anat Eini ◽  
Moshe Torem ◽  
Elad Schiff ◽  
...  
Keyword(s):  
Primary Care ◽  
Respiratory Tract ◽  
Essential Oils ◽  
Symptom Severity ◽  
Respiratory Tract Infections ◽  
Upper Respiratory Tract Infections ◽  
Study Group ◽  
Upper Respiratory Tract ◽  
Upper Respiratory ◽  
Tract Infections

This study is a prospective randomized double-blind controlled trial whose aim was to investigate the clinical effects of aromatic essential oils in patients with upper respiratory tract infections. The trial was conducted in six primary care clinics in northern Israel. A spray containing aromatic essential oils of five plants (Eucalyptus citriodora, Eucalyptus globulus, Mentha piperita, Origanum syriacum,andRosmarinus officinalis)as applied 5 times a day for 3 days and compared with a placebo spray. The main outcome measure was patient assessment of the change in severity of the most debilitating symptom (sore throat, hoarseness or cough). Sixty patients participated in the study (26 in the study group and 34 in the control group). Intention-to-treat analysis showed that 20 minutes following the spray use, participants in the study group reported a greater improvement in symptom severity compared to participants in the placebo group (). There was no difference in symptom severity between the two groups after 3 days of treatment (). In conclusion, spray application of five aromatic plants reported in this study brings about significant and immediate improvement in symptoms of upper respiratory ailment. This effect is not significant after 3 days of treatment.

scholarly journals Results from a Patient-Based Health Education Intervention in Reducing Antibiotic Use for Acute Upper Respiratory Tract Infections in the Private Sector Primary Care Setting in Singapore

2017 ◽  
Vol 61 (5) ◽  
Author(s):  
Magdalene Hui Min Lee ◽  
Darius Shaw Teng Pan ◽  
Joyce Huixin Huang ◽  
Mark I-Cheng Chen ◽  
Joash Wen Chen Chong ◽  
...  
Keyword(s):  
Primary Care ◽  
Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Care Setting ◽  
Primary Care Setting ◽  
Antibiotic Use ◽  
Upper Respiratory Tract Infections ◽  
Upper Respiratory Tract ◽  
Upper Respiratory ◽  
Tract Infections

ABSTRACT We investigated the efficacy of patient-targeted education in reducing antibiotic prescriptions for upper respiratory tract infections (URTIs) among adults in the private primary care setting in Singapore. Our randomized controlled trial enrolled patients aged 21 years and above presenting at general practitioner (GP) clinics with URTI symptoms for 7 days or less. Intervention arm patients were verbally educated via pamphlets about the etiology of URTIs, the role of antibiotics in treating URTIs, and the consequences of inappropriate antibiotic use. Control arm patients were educated on influenza vaccinations. Both arms were compared regarding the proportions prescribed antibiotics and the patients' postconsultation views. A total of 914 patients consulting 35 doctors from 24 clinics completed the study (457 in each arm). The demographics of patients in both arms were similar, and 19.1% were prescribed an antibiotic, but this varied from 0% to 70% for individual GPs. The intervention did not significantly reduce antibiotic prescriptions (odds ratio [OR], 1.20; 95% confidence interval [CI], 0.83–1.73) except in patients of Indian ethnicity (OR, 0.28; 95% CI, 0.09–0.93). Positive associations between the intervention and the view that antibiotics were not needed most of the time for URTIs (P = 0.047) and on being worried about the side effects of antibiotics (P = 0.018) were restricted to the Indian subgroup. GPs in limited liability partnerships or clinic chains prescribed less (OR, 0.36; 95% CI, 0.14 to 0.92), while certain inappropriate patient responses were associated with the receipt of antibiotics. Follow-up studies to investigate differences in responses to educational programs between ethnicities and to explore GP-targeted interventions are recommended.

The management of upper respiratory tract infections

2013 ◽  
Vol 99 (3) ◽  
pp. 97-105
Author(s):  
R Rennie ◽  
B Rennie
Keyword(s):  
Primary Care ◽  
Differential Diagnosis ◽  
Respiratory Tract ◽  
Clinical Picture ◽  
Respiratory Tract Infections ◽  
Upper Respiratory Tract Infections ◽  
Upper Respiratory Tract ◽  
Upper Respiratory ◽  
Tract Infections

AbstractUpper respiratory tract infections (URTIs), generally termed colds, sore throats and coughs, are common presentations in primary care. This article discusses the clinical picture, management, significant differential diagnosis, and specifically, when antibiotics may be required for an URTI.

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