Background: Antibiotics are frequently prescribed during viral respiratory infection episodes in primary care. There is limited information about antibiotic prescription during the SARS-CoV-2... Show moreBackground: Antibiotics are frequently prescribed during viral respiratory infection episodes in primary care. There is limited information about antibiotic prescription during the SARS-CoV-2 pandemic in primary care and its association with risk-factors for an adverse course.Aim: To compare the proportion of antibiotic prescriptions between patients with COVID-19 and influenza or influenza-like-symptoms, and to assess the association between antibiotic prescriptions and risk-factors for an adverse course of COVID-19.DesignAn observational cohort study using pseudonymised and coded routine healthcare data extracted from 85 primary care practices in the Netherlands.Method: Adult patients with influenza, influenza-like-symptoms, and suspected or confirmed COVID-19 during the period 2017 up until 2020 were included. We calculated proportions of antibiotic prescriptions for influenza and COVID-19 patients and odds ratios (ORs) comparing the associations of antibiotic prescriptions in COVID-19 patients with risk factors, hospital admission, intensive care (IC) admission, and mortality.Results: The proportion of antibiotic prescriptions during the first SARS-CoV-2 wave was lower than during the 2020 influenza season (9.6% vs 20.7%), difference 11.1% (95%CI:8.7-13.5). During the second SARS-CoV-2 wave, antibiotic prescriptions were associated with being older than 70 (OR 2.05 95% CI:1.43-2.93), the number of comorbidities (OR 1.46 95% CI:1.43-2.93) and admission to hospital (OR 3.19 95% CI:2.02-5.03) or IC (OR 4.64 95% CI:2.02-10.62).Conclusion: Antibiotic prescription was less common during the SARS-CoV-2 pandemic than during influenza seasons and associated with an adverse course and its risk factors. Our findings suggest a relatively targeted prescription policy of antibiotics in primary care during COVID.Keywords: Primary healthcare; SARS-CoV-2; antibiotics; influenza. Show less
Background Proton pump inhibitor (PPI) indications are limited to gastrointestinal disorders and ulcer prophylaxis. However, PPIs are among the most frequently prescribed drugs. Aim To evaluate the... Show moreBackground Proton pump inhibitor (PPI) indications are limited to gastrointestinal disorders and ulcer prophylaxis. However, PPIs are among the most frequently prescribed drugs. Aim To evaluate the appropriateness of PPI prescriptions and identify predictive factors for inappropriate PPI use. Design and setting Observational study using a Dutch primary care database with all new PPI prescriptions between 2016 and 2018. Method Individual patient data and details on PPI use were collected. The appropriateness of initiation and continuation of PPI prescriptions was evaluated using the applicable guidelines. Results In total, 148 926 patients (aged & GE;18 years) from 27 general practices were evaluated. A total of 23 601 (16%) patients started PPI therapy (mean age 57 [SD 17] years, 59% female). Valid PPI indications at initiation were seen in 10 466 PPI users (44%). Predictors for inappropriately initiated PPI use were older age (odds ratio [OR] 1.03, 95% confidence interval [CI] = 1.03 to 1.03), and use of non- selective non-steroidal anti-inflammatory drugs (OR 5.15, 95% CI = 4.70 to 5.65), adenosine diphosphate receptor inhibitors (OR 5.07, 95% CI = 3.46 to 7.41), COX-2 inhibitors (also known as coxibs) (OR 3.93, 95% CI = 2.92 to 5.28), and low-dose aspirin (OR 3.83, 95% CI = 3.07 to 4.77). Despite an initial valid indication, PPI use was inaccurately continued in 32% of patients on short-course therapy for dyspepsia and in 11% of patients on ulcer prophylaxis. Conclusion More than half of PPI users in primary care were found to have an inappropriate indication, with unnecessary ulcer prophylaxis related to drug use being one of the leading causes. Future initiatives to reduce PPI use for unnecessary ulcer prophylaxis and timely deprescription if PPI is no longer indicated, are needed. Show less
