Variability of antibiotic prescribing in patients with chronic obstructive pulmonary disease exacerbations: a cohort study

BMC Pulmonary Medicine

Tjeerd-Pieter van Staa⁶  Munir Pirmohamed³  Susan Eaton⁴  Jackie Cassell¹  Martin Gulliford⁷  Liam Smeeth⁶  Richard Hubbard²  Rachael Boggon⁵ 

[1] Division of Primary Care and Public Health, Brighton and Sussex Medical School, University of Brighton, Brighton, UK;Division of Epidemiology and Public Health, Nottingham University, Nottingham, UK;The Wolfson Centre for Personalised Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, UK;Clinical Practice Research Datalink, Medicines and Healthcare products Regulatory Agency, 151 Buckingham Palace Road, London SW1W 9SZ, UK;Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands;London School of Hygiene & Tropical Medicine, London, UK;Primary Care and Public Health Sciences, King’s College, London, UK

关键词: General practice;    Primary health care;    Anti-bacterial agents;    Clinical practice variation;    Disease exacerbation;    Chronic obstructive pulmonary disease;   

Others  :  1122334
DOI  :  10.1186/1471-2466-13-32

 received in 2012-08-03, accepted in 2013-05-29,  发布年份 2013

【 摘 要 】

Background

The role of antibiotics in treating mild or moderate exacerbations in patients with acute chronic obstructive pulmonary disease (COPD) is unclear. The aims were to: (i) describe patient characteristics associated with acute exacerbations amongst a representative COPD population, (ii) explore the relationship between COPD severity and outcomes amongst patients with exacerbations, and (iii) quantify variability by general practice in prescribing of antibiotics for COPD exacerbations.

Method

A cohort of 62,747 patients with COPD was identified from primary care general practices (GP) in England, and linked to hospital admission and death certificate data. Exacerbation cases were matched to three controls and characteristics compared using conditional logistic regression. Outcomes were compared using incidence rates and Cox regression, stratified by disease severity. Variability of prescribing at the GP level was evaluated graphically and by using multilevel models.

Results

COPD severity was found to be associated with exacerbation and subsequent mortality (very severe vs. mild, odds ratio for exacerbation 2.12 [95%CI 19.5–2.32]), hazard ratio for mortality 2.14 [95%CI 1.59–2.88]). Whilst 61% of exacerbation cases were prescribed antibiotics, this proportion varied considerably between GP practices (interquartile range, 48–73%). This variation is greater than can be explained by patient characteristics alone.

Conclusions

There is significant variability between GP practices in the prescribing of antibiotics to COPD patients experiencing exacerbations. Combined with a lack of evidence on the effects of treatment, this supports the need and opportunity for a large scale pragmatic randomised trial of the prescribing of antibiotics for COPD patients with exacerbations, in order to clarify their effectiveness and long term outcomes whilst ensuring the representativeness of subjects.

【 授权许可】

   
2013 Boggon et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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