Antibiotic prescription in ambulatory care for COVID-19 patients: a cohort analysis in four European countries

OBJECTIVE

To analyse antibiotic prescription rates in ambulatory care for COVID-19 patients by general practitioners (GPs) in four European countries.

METHODS

A total of 4,513,955 anonymised electronic prescribing records of 3656 GPs in four European countries were analysed. Diagnosis and prescriptions were retrieved. Antibiotic prescription rates during COVID-19 consultations were analysed and compared between France, the UK, Belgium and Romania.

RESULTS

Overall prescription rate was in France and Belgium (6.66 and 7.46%). However, analysing median GP prescribing rates, we found that 33.9% of the GPs in Belgium prescribed antibiotics with a median of 16 prescriptions per 100 COVID-19 consultations, while 55.21% of the GPs in France prescribed a median of 8 antibiotic prescriptions per 100 COVID-19 consultations. Overall antibiotic prescription rates were less in Romania than in the UK (22% vs 32%); however, 73% of the Romanian GPs vs 57% of the British GPs prescribed antibiotics. Depending on the country, the proportion of each type of antibiotic was statistically different, with the proportion of azithromycin being more than 50% of all antibiotics in each country except for the UK where it was less than 1%.

CONCLUSION

Both individual GPs prescribing patterns in addition to overall consumption patterns should be analysed in order to implement a tailored antimicrobial stewardship programme. Furthermore, antibiotic prescribing rates in COVID-19 are lower than other respiratory tract infections.

Association Between Diseases and Symptoms Diagnosed in Primary Care and the Subsequent Specific Risk of Multiple Sclerosis

BACKGROUND AND OBJECTIVES

Previous studies have reported a possible prodrome in multiple sclerosis (MS) defined by nonspecific symptoms including mood disorder or genitourinary symptoms and increased health care use detected several years before diagnosis. This study aimed to evaluate agnostically the associations between diseases and symptoms diagnosed in primary care and the risk of MS relative to controls and 2 other autoimmune inflammatory diseases with similar population characteristics, namely lupus and Crohn disease (CD).

METHODS

A case-control study was conducted using electronic health records from the Health Improvement Network database in the United Kingdom and France. We agnostically assessed the associations between 113 diseases and symptoms in the 5 years before and after diagnosis in patients with subsequent diagnosis of MS. Individuals with a diagnosis of MS were compared with individuals without MS and individuals with 2 other autoimmune diseases, CD and lupus.

RESULTS

The study population consisted of patients with MS (n = 20,174), patients without MS (n = 54,790), patients with CD (n = 30,477), and patients with lupus (n = 7,337). Twelve ICD-10 codes were significantly positively associated with the risk of MS compared with controls without MS. After considering ICD-10 codes suggestive of neurologic symptoms as the first diagnosis of MS, 5 ICD-10 codes remained significantly associated with MS: depression (UK: odds ratio 1.22, 95% CI 1.11-1.34), sexual dysfunction (1.47, 1.11-1.95), constipation (1.5, 1.27-1.78), cystitis (1.21, 1.05-1.39), and urinary tract infections of unspecified site (1.38, 1.18-1.61). However, none of these conditions was selectively associated with MS in comparisons with both lupus and CD. All 5 ICD-10 codes identified were still associated with MS during the 5 years after diagnosis.

DISCUSSION

We identified 5 health conditions associated with subsequent MS diagnosis, which may be considered not only prodromal but also early-stage symptoms. However, these health conditions overlap with prodrome of 2 other autoimmune diseases; hence, they lack specificity to MS.

Prescription of antibiotics by general practitioners in patients with a diagnosis of SARS- CoV-2 infection: analysis of an electronic French health record

OBJECTIVE

To define the factors associated with overprescription of antibiotics by general practitioners for patients diagnosed with COVID-19 during the first wave.

METHODS

Anonymized electronic prescribing records of 1370 physicians were analyzed. Diagnosis and prescriptions were retrieved. The initiation rate by physician for 2020 was compared to 2017-2019. Prescribing habits of physicians who initiated antibiotics for more than 10% of COVID-19 patients were compared to those who did not. Regional differences in prescribing habits of physicians who have seen at least one COVID-19 patient were also analyzed.

RESULTS

For the March-April 2020 period, physicians who initiated antibiotics for more than 10% of COVID-19 patients had more consultations than those who did not. They also prescribed antibiotics more frequently for non-COVID-19 patients consulting with rhinitis. They also prescribed broad-spectrum antibiotics more frequently for treatment of cystitis. Finally, doctors in Île-de-France region saw more COVID-19 patients and initiated antibiotics more frequently. General Practitioners in southern France had a higher but non-significant ratio of azithromycin initiation rate over total antibiotics initiation rate.

CONCLUSION

We identified a subset of physicians with overprescribing profile not only for COVID-19 but also for other viral infection, and also with a tendency to prescribe broad spectrum antibiotics for a long duration. There were also regional differences concerning antibiotics initiation rate and the ratio of azithromycin prescribed. It will be necessary to evaluate the evolution of prescribing practices during subsequent waves.