101 Comparing antibiotic prescriptions in primary care between SARS-CoV-2 and influenza 4 antibiotic prescriptions per patient contact was higher during the first wave, 9.6% (95% CI = 7.9 to 11.4), than during the second wave 2.7% (95% CI = 1.4 to 4.0). Influenza season 2020 had the lowest number of antibiotic prescriptions per contact (20.7%) of any influenza season analysed in the study. This was higher than during the first and second SARS-CoV-2 waves 9.6% (95% CI = 7.9 to 11.4) and 2.7% (95% CI = 1.4 to 4.0), respectively (Table 4). All influenza seasons had a higher proportion of antibiotic prescriptions per patient contact compared with both SARS-CoV-2 waves (Table 4). During the second wave, a higher proportion of the patients with suspected COVID-19 were prescribed antibiotics, 5.0% (95% CI = 3.8 to 6.2), compared with patients with confirmed COVID-19, 2.5% (95% CI = 1.3 to 3.7). During, the first wave, the proportion of prescribed antibiotics per contact was for patients with suspected, or confirmed COVID-19, 10.7% (95% CI = 7.8 to 13.6) and 6.1% (95% CI = 3.9 to 9.0), respectively. Similar effect estimates were found with multivariate logistic regression using original or pooled imputed data. Therefore, results from multivariate logistic regression with pooled imputed data are presented. During the second wave, an antibiotic prescription was positively associated with an age of ≥70 years (OR 2.05; 95% CI = 1.43 to 2.93), the number of comorbidities (OR 1.46; 95% CI = 1.18 to 1.82) (Figure 1), a hospital admission (OR 3.19; 95% CI = 2.02 to 5.03) or ICU admission (OR; 4.64 95% CI = 2.02 to 10.62) (Figure 2). Discussion Summary In this study, the frequencies of antibiotic prescription during SARS-CoV-2 episodes were compared with those of preceding influenza episodes. Antibiotic prescriptions were found to be less frequently used in primary care during SARS-CoV-2 waves than during influenza seasons 2017 up to and including 2020. Antibiotic prescriptions during the second SARS-CoV-2 wave were associated with older age, the number of comorbidities and also with hospital or ICU admission later. This association was not observed during the first wave. Comparison with existing literature In the study population, antibiotics were prescribed for 20–30% of patients with influenza-like illness or influenza. This may, according to the guidelines, be interpreted as inappropriate prescription. Other Dutch studies likewise show excessive antibiotic prescription during viral RTI episodes by GPs (6,16,17). However, these studies include
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