Opportunities to reduce antibiotic prescribing for patients with COPD in primary care: a cohort study using electronic health records from the Clinical Practice Research Datalink (CPRD).
Adult
Aged
Aged, 80 and over
Anti-Bacterial Agents
/ therapeutic use
Antimicrobial Stewardship
/ methods
Drug Prescriptions
/ standards
Electronic Health Records
Female
Humans
Male
Middle Aged
Practice Patterns, Physicians'
Primary Health Care
/ statistics & numerical data
Pulmonary Disease, Chronic Obstructive
/ drug therapy
Retrospective Studies
Risk Factors
Severity of Illness Index
United Kingdom
Journal
The Journal of antimicrobial chemotherapy
ISSN: 1460-2091
Titre abrégé: J Antimicrob Chemother
Pays: England
ID NLM: 7513617
Informations de publication
Date de publication:
01 01 2020
01 01 2020
Historique:
received:
18
06
2019
revised:
21
08
2019
accepted:
27
08
2019
pubmed:
11
10
2019
medline:
17
4
2021
entrez:
11
10
2019
Statut:
ppublish
Résumé
In primary care there is uncertainty about which patients with acute exacerbations of COPD (AECOPD) benefit from antibiotics. To identify which types of COPD patients get the most antibiotics in primary care to support targeted antibiotic stewardship. Observational study of COPD patients using a large English primary care database with 12 month follow-up. We estimated the incidence of and risk factors for antibiotic prescribing relative to the number of AECOPD during follow-up, considering COPD severity, smoking, obesity and comorbidity. From 157 practices, 19594 patients were diagnosed with COPD, representing 2.6% of patients and 11.5% of all prescribed antibiotics. Eight hundred and thirty-three (4.5%) patients with severe COPD and frequent AECOPD were prescribed six to nine prescriptions per year and accounted for 13.0% of antibiotics. Individuals with mild to moderate COPD and zero or one AECOPD received one to three prescriptions per year but accounted for 42.5% of all prescriptions. In addition to COPD severity, asthma, chronic heart disease, diabetes, heart failure and influenza vaccination were independently associated with increased antibiotic use. Patients with severe COPD have the highest rates of antibiotic prescribing but most antibiotics are prescribed for patients with mild to moderate COPD. Antibiotic stewardship should focus on the dual goals of safely reducing the volume of prescribing in patients with mild to moderate COPD, and optimizing prescribing in patients with severe disease who are at significant risk of drug resistance.
Sections du résumé
BACKGROUND
In primary care there is uncertainty about which patients with acute exacerbations of COPD (AECOPD) benefit from antibiotics.
OBJECTIVES
To identify which types of COPD patients get the most antibiotics in primary care to support targeted antibiotic stewardship.
METHODS
Observational study of COPD patients using a large English primary care database with 12 month follow-up. We estimated the incidence of and risk factors for antibiotic prescribing relative to the number of AECOPD during follow-up, considering COPD severity, smoking, obesity and comorbidity.
RESULTS
From 157 practices, 19594 patients were diagnosed with COPD, representing 2.6% of patients and 11.5% of all prescribed antibiotics. Eight hundred and thirty-three (4.5%) patients with severe COPD and frequent AECOPD were prescribed six to nine prescriptions per year and accounted for 13.0% of antibiotics. Individuals with mild to moderate COPD and zero or one AECOPD received one to three prescriptions per year but accounted for 42.5% of all prescriptions. In addition to COPD severity, asthma, chronic heart disease, diabetes, heart failure and influenza vaccination were independently associated with increased antibiotic use.
CONCLUSIONS
Patients with severe COPD have the highest rates of antibiotic prescribing but most antibiotics are prescribed for patients with mild to moderate COPD. Antibiotic stewardship should focus on the dual goals of safely reducing the volume of prescribing in patients with mild to moderate COPD, and optimizing prescribing in patients with severe disease who are at significant risk of drug resistance.
Identifiants
pubmed: 31598669
pii: 5584403
doi: 10.1093/jac/dkz411
pmc: PMC6910166
doi:
Substances chimiques
Anti-Bacterial Agents
0
Types de publication
Journal Article
Observational Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
243-251Subventions
Organisme : Department of Health
ID : CS-2016-16-007
Pays : United Kingdom
Organisme : Wellcome Trust
Pays : United Kingdom
Informations de copyright
© The Author(s) 2019. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy.
Références
Respir Med. 2010 Jul;104(7):1027-34
pubmed: 20116231
ERJ Open Res. 2017 Jun 19;3(2):
pubmed: 28656132
BMJ Open. 2014 Jul 23;4(7):e005540
pubmed: 25056980
Arch Bronconeumol. 2019 Jul 15;:null
pubmed: 31320191
Int J Chron Obstruct Pulmon Dis. 2016 Dec 08;11:3109-3119
pubmed: 27994450
Int J Epidemiol. 2015 Jun;44(3):827-36
pubmed: 26050254
BMJ Open. 2014 Dec 18;4(12):e006171
pubmed: 25524545
Am J Respir Crit Care Med. 2018 Aug 15;198(4):464-471
pubmed: 29474094
J Antimicrob Chemother. 2018 Feb 1;73(suppl_2):ii2-ii10
pubmed: 29490062
Int J Chron Obstruct Pulmon Dis. 2009;4:203-23
pubmed: 19554195
PLoS One. 2016 Mar 09;11(3):e0151357
pubmed: 26959820
J Antimicrob Chemother. 2018 Feb 1;73(suppl_2):19-26
pubmed: 29490060
BMJ. 2010 May 18;340:c2096
pubmed: 20483949
BMC Pulm Med. 2013 May 31;13:32
pubmed: 23724907
J Antimicrob Chemother. 2017 Jun 1;72(6):1818-1824
pubmed: 28333200
Chest. 2000 Jun;117(6):1638-45
pubmed: 10858396
N Engl J Med. 2019 Jul 11;381(2):111-120
pubmed: 31291514
Cochrane Database Syst Rev. 2018 Oct 29;10:CD010257
pubmed: 30371937