Survey

Are you willing to give informed consent for participation in the study?

Yes No

Do you have a new continuous cough, and/or high temperature, and/or a loss of or change in your normal taste or sense of smell, which have been present for less than 15 days?

Yes No

Defined:
A new continuous cough - this means coughing a lot for more than an hour, or 3 or more coughing episodes in 24 hours (if you usually have a cough, it may be worse than usual)
and/or
A high temperature - this means you feel hot to touch on your chest or back
(you do not need to take your temperature)

What date did you start to feel unwell with this illness?

- -

Are you feeling almost recovered from this illness (i.e. generally much improved and your symptoms are now mild or almost absent)?

Yes No

Have you had a positive test for COVID-19 infection?

Yes No

What date was this COVID-19 test taken?

- -

Are you unwell with symptoms of COVID-19?
These symptoms may include, but are not limited to, shortness of breath, general feeling of being unwell, muscle pain, diarrhoea and vomiting.

Yes No

What date did you start to feel unwell with this illness?

- -

Are you feeling almost recovered from this illness
(i.e. generally much improved and your symptoms are now mild or almost absent)?

Yes No

Are you aged 65 years old or over?

Yes No

Are you aged 50 to 64 years old with at least one of the comorbidities/conditions listed below?

weakened immune system due to a serious illness or medication (e.g. chemotherapy)
heart disease or high blood pressure
asthma or lung disease
known diabetes
liver disease
stroke or neurological problem

Yes No

Are you aged 50 to 64 years old
and have a body mass index (BMI) at or above 35 kg/m²?

Click here if you need to calculate your BMI

Yes No

Are you pregnant or planning on becoming pregnant within the next few weeks?

Yes No

Are you breastfeeding or planning on starting during the course of the trial?

Yes No

Do you have myasthenia gravis (a rare type of neuromuscular disorder)?

Yes No

Are you currently admitted in hospital?

Yes No

Do you have a specific heart rhythm abnormality called "prolonged QT syndrome" or condition that prolongs the heart QT interval?

Yes No

Have you previously participated in the PRINCIPLE trial?

Yes No

Are you currently taking antibiotics for a recently diagnosed illness?

Yes No

Do you have an allergy to soya or peanuts?

Yes No

Have you had a previous adverse reaction to azithromycin or any other macrolides
(e.g. erythromycin, clarithromycin or spiramycin)?

Yes No

Are you currently taking azithromycin or any other macrolides
(e.g. erythromycin, clarithromycin or spiramycin)?

Yes No

Are you currently taking any of the following drugs?

Conditions have been provided for the most common uses of these drugs, but these drugs may be used for other conditions not listed here. If you take any of these drugs for any reason, even if not listed here, please respond with "Yes".

commonly used to treat heart conditions:

Amiodarone
Digoxin
Sotalol

commonly used to treat migranes:

Ergotamine
Methysergide

commonly used to treat parkinson's, tumours, hyperprolactinaemia:

Bromocriptine

commonly used to treat hyperprolactinaemia:

Cabergoline

commonly used to treat athritis or psoriasis:

Ciclosporin

commonly used to treat malaria or athritis:

Hydroxychloroquine or Chloroquine

commonly used to treat heavy vaginal bleeding after childbirth:

Ergometrine

Yes No

Have you had a previous adverse reaction to doxycycline or any other tetracyclines
(e.g. lymecycline, chlortetracycline, minocin/minocycline, oxytetracycline or tetracycline)?

Yes No

Are you currently taking doxycycline or any other tetracyclines
(e.g. lymecycline, chlortetracycline, minocin/minocycline, oxytetracycline or tetracycline)?

Yes No

Sucrose intolerance (i.e. rare hereditary problems of fructose intolerance, glucose galactose malabsorption or sucrose-isomaltase insufficiency)?

Yes No

Are you currently taking any of the following drugs?

commonly used to treat athritis or psoriasis:

Ciclosporin

commonly used to treat psoriasis:

Retinoids (e.g. acitretin, alitretinoin, isotretinoin, tretinoin)

commonly used for chemotherapy:

Methotrexate

commonly used to treat migraines:

Ergotamine

commonly used to treat pain:

Methoxyflurane

commonly used to treat bipolar or major depressive disorder:

Lithium

Yes No

Do you have systemic lupus erythematosus?

Yes No

If other, please specify

After you have answered all the questions on this form and clicked "I'm not a robot" below
please click the "Submit" button at the bottom of the page to proceed to your Consent Form

PRINCIPLE Participant Registration v6.5 03-09-2020
REC Number: 20/SC/058, IRAS Number: 281958, EudraCT Number: 2020-001209-22, Chief Investigator: Professor Christopher Butler