Associations with antibiotic prescribing for acute exacerbation of COPD in primary care: secondary analysis of a randomised controlled trial
Royal College of General Practioners
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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.
British Journal of General Practice;
Gillespie, D., Butler, C., Bates, J., Hood, K., Melbye, H., Phillips, R., Stanton, H., Alam, M.F., Cals, J., Cochrane, A., Kirby, N. et al (2021) 'Associations with antibiotic prescribing for acute exacerbation of COPD in primary care', British Journal of General Practice. https://doi.org/10.3399/BJGP.2020.0823
Article published in British Journal of General Practice available at https://doi.org/10.3399/BJGP.2020.0823
Cardiff Metropolitan University (Grant ID: Cardiff Metropolian (Internal))
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C-reactive protein point-of-care testing for safely reducing antibiotics for acute exacerbations of chronic obstructive pulmonary disease: the PACE RCT Francis, Nick; Gillespie, David; White, Patrick; Bates, Janine; Lowe, Rachel; Sewell, B.; Phillips, Rhiannon (NIHR Journals Library, 2020-03)Background: Most patients presenting with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) in primary care are prescribed antibiotics, but these may not be beneficial, and they can cause side effects ...
General practitioner use of a C-reactive protein point-of-care test to help target antibiotic prescribing in patients with acute exacerbations of chronic obstructive pulmonary disease (the PACE study): study protocol for a randomised controlled trial Bates, J.; Francis, N.A.; White, P.; Gillespie, D.; Thomas-Jones, E.; Breen, R.; Kirby, N.; Hood, K.; Gal, M.; Phillips, Rhiannon; Naik, G. (BMC (Springer Nature), 2017-09-29)Background Most patients presenting with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) in primary care are prescribed an antibiotic, which may not always be appropriate and may cause harm. C-reactive ...
Phillips, Rhiannon; Stanton, Helen; Singh-Hehta, Amina; Gillespie, David; Bates, Janine; Gal, Micaela; Thomas-Jones, Emma; Lowe, Rachel; Hood, Kerenza; Llor, Carl; Melbye, Hasse; Cals, Jochen; White, Patrick; Butler, Christopher C.; Francis, Nick (Royal College of General Practitioners, 2020-05-18)Background: Antibiotics are prescribed to over 70% of patients presenting in primary care with an acute exacerbation of chronic obstructive pulmonary disease (AECOPD). The PACE randomised controlled trial found that a ...