Associations with antibiotic prescribing for acute exacerbation of COPD in primary care: secondary analysis of a randomised controlled trial
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Associations with antibiotic prescribing for acute exacerbation of COPD in primary care : secondary analysis of a randomised controlled trial. / Gillespie, David; Butler, Christopher C.; Bates, Janine; Hood, Kerenza; Melbye, Hasse; Phillips, Rhiannon; Stanton, Helen; Alam, Mohammed Fasihul; Cals, Jochen Wl; Cochrane, Ann; Kirby, Nigel; Llor, Carl; Lowe, Rachel; Naik, Gurudutt; Riga, Evgenia; Sewell, Bernadette; Thomas-Jones, Emma; White, Patrick; Francis, Nick A.
I: The British journal of general practice : the journal of the Royal College of General Practitioners, Bind 71, Nr. 705, 2021, s. e266-e272.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Associations with antibiotic prescribing for acute exacerbation of COPD in primary care
T2 - secondary analysis of a randomised controlled trial
AU - Gillespie, David
AU - Butler, Christopher C.
AU - Bates, Janine
AU - Hood, Kerenza
AU - Melbye, Hasse
AU - Phillips, Rhiannon
AU - Stanton, Helen
AU - Alam, Mohammed Fasihul
AU - Cals, Jochen Wl
AU - Cochrane, Ann
AU - Kirby, Nigel
AU - Llor, Carl
AU - Lowe, Rachel
AU - Naik, Gurudutt
AU - Riga, Evgenia
AU - Sewell, Bernadette
AU - Thomas-Jones, Emma
AU - White, Patrick
AU - Francis, Nick A.
PY - 2021
Y1 - 2021
N2 - BACKGROUND: C-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. AIM: To investigate the associations between presenting features and antibiotic prescribing in patients with AECOPD in primary care. DESIGN AND SETTING: Secondary analysis of a randomised controlled trial of participants presenting with AECOPD in primary care (the PACE trial). METHOD: Clinicians 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). RESULTS: A 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] = 3.24 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 1.00), as was the presence of heart failure (AOR = 0.32, 95% CI = 0.12 to 0.85). CONCLUSION: Several 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 safe reductions.
AB - BACKGROUND: C-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. AIM: To investigate the associations between presenting features and antibiotic prescribing in patients with AECOPD in primary care. DESIGN AND SETTING: Secondary analysis of a randomised controlled trial of participants presenting with AECOPD in primary care (the PACE trial). METHOD: Clinicians 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). RESULTS: A 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] = 3.24 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 1.00), as was the presence of heart failure (AOR = 0.32, 95% CI = 0.12 to 0.85). CONCLUSION: Several 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 safe reductions.
KW - antibiotics
KW - C-reactive protein
KW - COPD
KW - primary care
KW - randomised controlled trial
U2 - 10.3399/BJGP.2020.0823
DO - 10.3399/BJGP.2020.0823
M3 - Journal article
C2 - 33657007
AN - SCOPUS:85103608200
VL - 71
SP - e266-e272
JO - British Journal of General Practice
JF - British Journal of General Practice
SN - 0960-1643
IS - 705
ER -
ID: 260400480