Article Text
Abstract
Introduction Antibiotics are routinely given to people with chronic obstructive pulmonary disease (COPD) presenting with lower respiratory tract infection (LRTI) symptoms in primary care. Population prescribing habits and their consequences have not been well-described.
Methods We conducted a retrospective analysis of antibiotic prescriptions for non-pneumonic exacerbations of COPD from 2010 to 2015 using the UK primary care Optimum Patient Care Research Database. As a proxy of initial treatment failure, second antibiotic prescriptions for LRTI or all indications within 14 days were the primary and secondary outcomes, respectively. We derived a model for repeat courses using univariable and multivariable logistic regression analysis.
Results A total of 8.4% of the 9042 incident events received further antibiotics for LRTI, 15.5% further courses for any indication. Amoxicillin and doxycycline were the most common index and second-line drugs, respectively (58.7% and 28.7%), mostly given for 7 days. Index drugs other than amoxicillin, cardiovascular disease, pneumococcal vaccination and more primary care consultations were statistically significantly associated with repeat prescriptions for LRTI (p<0.05). The ORs and 95% CIs were: OR 1.28, 95% CI 1.10 to 1.49; OR 1.37, 95% CI 1.13 to 1.66; OR 1.33, 95% CI 1.14 to 1.55 and OR 1.05, 95% CI 1.02 to 1.07, respectively. Index duration, inhaled steroid use and exacerbation frequency were not statistically significant. The derived model had an area under the curve of 0.61, 95% CI 0.59 to 0.63.
Discussion The prescription of multiple antibiotic courses for COPD exacerbations was relatively common—one in twelve patients receiving antibiotics for LRTI had a further course within 2 weeks. The findings support the current preference for amoxicillin as index drug within the limitations of this observational study. Further clinical trials to determine best practice in this common clinical situation appear required.
- anti-bacterial agents
- lower respiratory tract infections
- treatment failure
- chronic obstructive
- Pulmonary Disease
- primary healthcare
This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
Statistics from Altmetric.com
Footnotes
Contributors JDB and MS conceived the idea for this work and are the guarantors. MS completed the data analysis and manuscript preparation. LJB supported the statistical analysis. All the authors contributed to data interpretation and critically revised the manuscript. All the authors read and approved the final manuscript.
Funding We are grateful to the Eleanor Peel Trust for providing funding for bespoke data extraction and database creation from the OPC. MS is funded by a National Institute for Health Research (NIHR) Academic Clinical Fellowship. LJB is funded by an NIHR Post-Doctoral Fellowship (PDF-2015-08-044).
Disclaimer The views expressed in this publication are those of the authors and not necessarily those of the National Health Service, the National Institute for Health Research or the Department of Health.
Competing interests JDB reports personal fees from Novartis and Teva, personal fees and non-financial support from AstraZeneca and Boehringer Ingelheim, and non-financial support from Virginia Commonwealth University and Respiratory Effectiveness Group, outside the submitted work. However, none of these relates to the topic of this submission.
Patient consent for publication Not required.
Ethics approval The OPCRD was approved by the Trent Multi-Centre Research Ethics Committee for clinical research use. This study protocol was approved by the OPCRD’s Anonymised Data Ethics Protocols and Transparency Committee. There was no direct patient and public involvement (PPI) in this study, but the OPCRD was developed with PPI and is updated by a committee that includes patient representatives.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data may be obtained from a third party and are not publicly available.