Takeaway
- Prescribing drugs other than amoxicillin, but not shorter drug courses, is linked to antibiotic treatment failure for lower respiratory tract infections (LRTIs) in primary care COPD patients.
Why this matters
- Up to 50% of exacerbations are bacterial.
- There is limited understanding of success of real-world prescribing practices for COPD infectious exacerbations.
Study design
- Retrospective cohort of 9042 incident events (index antibiotic courses) for LRTIs in COPD patients documented in the UK primary care Optimum Patient Care Research Database (2010-2015).
- Treatment failure, the primary outcome, was defined by receiving a second course of antibiotics within 14 days of the index treatment.
- Funding: Eleanor Peel Trust.
Key results
- The most common index drugs were doxycycline (28.7%), erythromycin/clarithromycin (27.3%), and amoxicillin (25.8%).
- 8.4% of the 9042 incident events were treatment failures.
- The most common factors associated with treatment failures:
- Not prescribing amoxicillin as index antibiotic (HR, 1.28; 95% CI, 1.10-1.49);
- Having a cardiovascular disease diagnosis (HR, 1.37; 95% CI, 1.13-1.66);
- Prior pneumococcal vaccination (HR, 1.33; 95% CI, 1.14-1.55); and
- Higher number of primary care respiratory consultations in the year prior to the index prescription (HR, 1.05; 95% CI, 1.02-1.07).
- Index antibiotic duration, inhaled steroid use, and exacerbation frequency were not associated with treatment failure.
Limitations
- Observational design.
References
References
