COPD exacerbations: what causes antibiotic treatment failure?

  • BMJ Open Resp Res

  • International Clinical Digest
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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.