A study has identified several demographic and clinical factors associated with antibiotic prescribing in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). The findings were published in the British Journal of General Practice.
With more than 70 per cent of patients experiencing AECOPD being prescribed antibiotics, there are growing concerns regarding antibiotic overuse and consequent antimicrobial resistance. The PACE randomised controlled trial (RCT) trial showed that the use of C-reactive protein point-of-care testing (CRP-POCT) for patients with AEPOCD could cut down antibiotic use without harming patients.
Researchers conducted a secondary analysis of the PACE trial involving 649 participants (325 assigned to CRP-POCT and 324 to usual care) from 86 general practices across England and Wales.
Clinical features including, clinician-recorded crackles (adjusted OR [aOR], 5.22; 95% CI, 3.24-8.41), wheezing (aOR, 1.64; 95% CI, 1.07-2.52), diminished vesicular breathing (aOR, 2.95; 95%CI, 1.70-5.10) or evidence of consolidation (aOR, 34.40; 95% CI, 2.84-417.27) were associated with higher odds of antibiotic prescribing for AECOPD. Conversely, increased age (aOR per-year increase, 0.98; 95% CI, 0.95-1.00) and heart failure (aOR, 0.32; 95% CI, 0.12-0.85) were associated with lower odds of antibiotic prescribing.
The authors call for further research to explore the diagnostic and prognostic utility of these factors and whether there is scope for further safe reduction of antibiotic use in patients with AECOPD.
