Real-life data on antibiotic prescription and sputum culture diagnostics in acute exacerbations of COPD in primary care

Abstract

BackgroundAcute exacerbations of chronic obstructive pulmonary disease (AECOPD) are generally treated with optimization of bronchodilation therapy and a course of oral corticosteroids, mostly without antibiotics. The Dutch guidelines recommend prudent use of antibiotics, with amoxicillin or doxycycline as first choice. Here we evaluate adherence to these guidelines with regard to antibiotic prescription in AECOPD in primary care and the use of sputum cultures.MethodsWe retrospectively analyzed a longitudinal cohort of patients in three primary care practices in the north-eastern region of the Netherlands from 2009 to 2013 (n=36,172 subjects) participating in the Registration Network Groningen. Antibiotics prescribed for AECOPD −10/+28 days from the start date of corticosteroid courses were evaluated. In addition, we assessed regional data on the susceptibility of respiratory pathogens from COPD patients.ResultsWe identified 1,297 patients with COPD. Of these, 616 experienced one or more exacerbations, resulting in a total of 1,558 exacerbations, for which 1,594 antibiotic courses were prescribed. The recommended antibiotics doxycycline and amoxicillin accounted for 56% of the prescribed antibiotics overall and for 35% in subsequent antibiotic courses. The alternative choices were not based on culture results because only in 67 AECOPD events (2.9%) sputum samples were taken. Regional data including 3,638 sputum samples showed that pathogens relevant in AECOPD were detected in 19% of cultures.ConclusionOur study shows that guidelines regarding the prescription of antibiotics are poorly followed, particularly in recurrent exacerbations. Sputum cultures were performed in a small minority of cases. Performing sputum diagnostics in patients with early treatment failure or a repeated exacerbation when antibiotic treatment is started may further rationalize antibiotic treatment.

Influence of age on real-life effects of doxycycline for acute exacerbations among COPD outpatients: a population-based cohort study

“…The average age of study patients (about 70 years) was comparable with previous studies 36. We did not find a short-term benefit of doxycycline in the younger age group (<75), which may be explained by the fact that the overall rate of appropriate antibiotic use in practice is rather low 17–19. According to GOLD (Global Initiative for Chronic Obstructive Lung Disease), general practitioners should only consider antibiotics for patients when signs of bacterial infection are present 5.…”

“…According to GOLD (Global Initiative for Chronic Obstructive Lung Disease), general practitioners should only consider antibiotics for patients when signs of bacterial infection are present 5. However, in reality, guidelines regarding the prescription of antibiotics are poorly followed,17 19 on average in only 25% of AECOPD antibiotics were prescribed properly according to the GOLD criteria 18. For AECOPD with other aetiology like viral infection and environmental pollution, antibiotics may not have been effective.…”

“…The majority of AECOPD is treated in primary care and establishing a bacterial infection diagnosis with sputum cultures is not always feasible in routine practice due to technical reasons 5 16. Therefore, accurate prescribing of antibiotics according to guidelines is still low 17–19. Notably, many studies indicate that the susceptibility to infections increases with age 20 21.…”

<p>Comparative Effectiveness Of Fluoroquinolone Antibiotic Use In Uncomplicated Acute Exacerbations Of COPD: A Multi-Cohort Study</p>

“…While these values are higher than the 20.4% fluoroquinolone use found in this study, our approach targeted only uncomplicated exacerbations of COPD. A small study of primary care practice in the Netherlands evaluated the antibiotic prescribing of 1297 patients with exacerbations of COPD 23. Only 2% of the patients with single exacerbations received fluoroquinolone prescriptions.…”

Static and dynamic hyperinflation during severe acute exacerbations of chronic obstructive pulmonary disease

“…3,25 Although efforts have been made to better define and prevent exacerbations in several recent trials, the treatment of an exacerbation in the hospital has remained mostly unchanged for the last 2 decades. 1,[26][27][28][29] Two previous studies assessed static hyperinflation in the setting of an acute exacerbation of COPD. Our results in inpatients are in line with the results of the study of Parker et al (n=20) who studied mostly outpatients with less severe exacerbations than in the current study.…”