103 Comparing antibiotic prescriptions in primary care between SARS-CoV-2 and influenza 4 department were tested. Until June 1 2020, GPs mainly based a COVID-19 diagnosis on the medical history, patient characteristic, reported and observed symptoms. Patients were advised to contact their GP if they experienced severe symptoms. This led to under-registration of COVID-19 patients in the first wave, leading to a higher proportion of patients with a severe course of COVID-19 being registered. From June 2020 onwards, all patients with symptoms could be tested for SARS-CoV-2 by the municipal health services and test results were quickly passed on to GPs. But patients could have to wait up to 3 days before a PCR test was performed and the results were passed on. Meanwhile, they may have contacted their GPs, leading to a registration of suspected COVID-19. At the start of the SARS-CoV-2 pandemic in The Netherlands, patients with (suspicion of) COVID-19 were not uniformly registered in the EMR with the same ICPC code. A separate ICPC code, R83.03 SARS-CoV-2, was introduced in November 2020, and slowly implemented. Most patients were registered according to their 'influenza-like' symptoms. For this reason, patients aged ≥18 years with the ICPC codes listed in Table 1 were selected broadly from the study population. As only respiratory ICPC codes were selected, asymptomatic patients with COVID-19 or patients with only non-respiratory symptoms associated with SARS-CoV-2 were potentially missed. Use of routinely collected healthcare data always carries a risk of missing data, as was the case in the present study. The authors feel confident missing data in the study is missing at random. The percentage of hospital admissions and mortality during the second wave were comparable with national percentages, suggesting any selection and registration bias in the second wave was low (12,21). As such, the analysis of the second wave was addressed in the primary discussion. Implications for research and practice It was found antibiotic prescriptions were given less often during SARS-CoV-2 waves compared with influenza seasons. This may be owing to proper testing of patients for COVID-19, along with a coinciding lower prevalence of influenza and other respiratory viruses, leading to less diagnostic uncertainty about potentially missing a bacterial infection. This may have led to more confidence in the diagnostic accuracy among physicians and hence to communicating a diagnosis to a patient with more certainty. As a result, antibiotics to prevent or treat a possible bacterial superinfection were largely restricted to those assessed to be at risk of developing or having a more adverse course of COVID-19. Since COVID-19 testing might be the most probable explanation of increased appropriateness in antibiotic prescriptions over time, rapid point-of-care tests for influenza and other viral RTIs may further reduce diagnostic uncertainty and result in fewer antibiotic prescriptions during viral RTI episodes. A Dutch study in
RkJQdWJsaXNoZXIy MTk4NDMw