Antimicrobial stewardship during the COVID-19 epidemic. Cohort study

Date of ISAC Approval: 
05/05/2020
Lay Summary: 
The COVID-19 pandemic has potential to impact on many areas of medical practice. This study aims to find out how antibiotic prescribing is changing during the pandemic. We expect that antibiotic prescribing will increase because large numbers of people are having symptoms of cough and chest infections. Primary care consultations may not be taking place in a face-to-face format, possibly leading to greater antibiotic prescribing. This study will analyse antibiotic prescribing in CPRD GOLD, later validating findings in CPRD Aurum. We will include all general practices in England that provide research quality data throughout 2017 to the present. We will analyse antibiotic prescriptions by month, as well as broad spectrum antibiotic prescriptions, and consultations for respiratory tract, urinary tract and skin infections as the common infections in primary care. Using graphs and statistical models, we will evaluate whether the pandemic has been associated with changes in infection consultations and antibiotic prescriptions. We will also evaluate numbers of COVID-19 consultations. The results will show how antibiotic prescribing has changed during the pandemic and will inform efforts to ensure antibiotics are used appropriately.
Technical Summary: 
The COVID-19 pandemic has potential to impact on many areas of medical practice. This study aims to determine how antibiotic prescribing is changing during the pandemic. We expect that antibiotic prescribing might increase because large numbers of people are having respiratory infections. Primary care consultations may not be taking place in a face-to-face format, possibly leading to greater antibiotic prescribing because clinical assessments are more limited. This study will analyse antibiotic prescribing in CPRD GOLD, later validating findings in CPRD Aurum. We will include all general practices in England that provide UTS data throughout 2017 to the present. We will take a random sample of registered patients, giving a total sample of 400,000-500,000. We will analyse antibiotic prescriptions by month, as well as broad spectrum antibiotic prescriptions, and consultations for respiratory tract, urinary tract and skin infections as the common infections in primary care. We will evaluate whether the pandemic has been associated with changes in infection consultations and antibiotic prescriptions. We will also evaluate numbers of COVID-19 consultations. We will visualise the data with a scatterplot of monthly rates, fitting smoothed curves to evaluate whether onset of the pandemic in February 2020 has been associated with any departures from trend. We will fit Poisson models to 2017 to 2019 data to predict expected antibiotic prescribing in 2020. We will also fit interrupted time series models. The results will show how antibiotic prescribing has changed during the pandemic and will inform continuing antimicrobial stewardship efforts.
Health Outcomes to be Measured: 
Antibiotic prescriptions, including sub-groups of broad-spectrum antibiotic prescriptions. Consultations for respiratory tract infections, urinary tract infections and skin infections. Consultations for COVID-19.
Collaborators: 

Martin Gulliford - Chief Investigator - King’s College London
Emma Rezel-Potts - Collaborator - King’s College London
Martin Gulliford - Corresponding Application - King’s College London

Linkages: 
Practice IMD (Standard)