Associations with antibiotic prescribing for acute exacerbation of COPD in primary care: secondary analysis of a randomised controlled trial

D. Gillespie*, C.C. Butler, J. Bates, K. Hood, H. Melbye, R. Phillips, H. Stanton, M.F. Alam, J.W.L. Cals, A. Cochrane, N. Kirby, C. Llor, R. Lowe, G. Naik, E. Riga, B. Sewell, E. Thomas-Jones, P. White, N.A. Francis

*Corresponding author for this work

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2 Citations (Web of Science)

Abstract

BackgroundC-reactive protein (CRP) point-of-care testing can reduce antibiotic use in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in primary care. without compromising patient care. Further safe reductions may be possible.AimTo investigate the associations between presenting features and antibiotic prescribing in patients with AECOPD in primary care.Design and settingSecondary analysis of a randomised controlled trial of participants presenting with AECOPD in primary care (the PACE trial).MethodClinicians collected participants demographic features. comorbid illnesses, clinical signs, and symptoms. Antibiotic prescribing decisions were made after participants were randomised to receive a point-of-care CRP measurement or usual care. Multivariable regression models were fitted to explore the association between patient and clinical features and antibiotic prescribing, and extended to further explore any interactions with CRP measurement category (CRP not measured, CRP <20 mg/l, or CRP >= 20 mg/l).ResultsA total of 649 participants from 86 general practices across England and Wales were included. Odds of antibiotic prescribing were higher in the presence of clinician-recorded crackles (adjusted odds ratio [AOR] = 5.22, 95% confidence interval [CI] = 324 to 8.41). wheeze (AOR =1.64, 95% CI =1.07 to 2.52), diminished vesicular breathing (AOR = 2.95.95% CI =1.70 to 5.10), or clinician reported evidence of consolidation (AOR = 34.40, 95% CI = 2.84 to 417.27). Increased age was associated with lower odds of antibiotic prescribing (AOR per additional year increase = 0.98, 95% CI = 0.95 to 1110), as was the presence of heart failure (AOR = 0.32, 95% CI = 0.12 to 0.85).ConclusionSeveral demographic features and clinical signs and symptoms are associated with antibiotic prescribing in AECOPD. Diagnostic and prognostic value of these features may help identify further sate reductions.
Original languageEnglish
Pages (from-to)E266-E272
Number of pages7
JournalBritish Journal of General Practice
Volume71
Issue number705
DOIs
Publication statusPublished - 1 Apr 2021

Keywords

  • C-reactive protein
  • COPD
  • antibiotics
  • primary care
  • randomised controlled trial
  • C-REACTIVE PROTEIN
  • MANAGEMENT
  • SPUTUM
  • PREVALENCE
  • ACUTE COUGH
  • OBSTRUCTIVE PULMONARY-DISEASE
  • THERAPY
  • CLINICAL FINDINGS
  • PACE
  • POINT

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