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Associations with antibiotic prescribing for acute exacerbation of COPD in primary care: secondary analysis of a randomised controlled trial

Associations with antibiotic prescribing for acute exacerbation of COPD in primary care: secondary analysis of a randomised controlled trial
Associations with antibiotic prescribing for acute exacerbation of COPD in primary care: secondary analysis of a randomised controlled trial

Background C-reactive protein (CRP) point-of-care testing can reduce antibiotic use in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in primary care, without compromising patient care. Further safe reductions may be possible.

Aim To investigate the associations between presenting features and antibiotic prescribing in patients with AECOPD in primary care.

Design and setting Secondary analysis of a randomised controlled trial of participants presenting with AECOPD in primary care (the PACE trial).

Method Clinicians collected participants’ demographic features, comorbid illnesses, clinical signs, and symptoms. Antibiotic prescribing decisions were made after participants were randomised to receive a point-of-care CRP measurement or usual care. Multivariable regression models were fitted to explore the association between patient and clinical features and antibiotic prescribing, and extended to further explore any interactions with CRP measurement category (CRP not measured, CRP <20 mg/l, or CRP ≥20 mg/l).

Results A total of 649 participants from 86 general practices across England and Wales were included. Odds of antibiotic prescribing were higher in the presence of clinician-recorded crackles (adjusted odds ratio [AOR] = 5.22, 95% confidence interval [CI] = 3.24 to 8.41), wheeze (AOR = 1.64, 95% CI = 1.07 to 2.52), diminished vesicular breathing (AOR = 2.95, 95% CI = 1.70 to 5.10), or clinician-reported evidence of consolidation (AOR = 34.40, 95% CI = 2.84 to 417.27). Increased age was associated with lower odds of antibiotic prescribing (AOR per additional year increase = 0.98, 95% CI = 0.95 to 1.00), as was the presence of heart failure (AOR = 0.32, 95% CI = 0.12 to 0.85).

Conclusion Several demographic features and clinical signs and symptoms are associated with antibiotic prescribing in AECOPD. Diagnostic and prognostic value of these features may help identify further safe reductions.

Antibiotics, C-reactive protein, COPD, Primary care, Randomised controlled trial
0960-1643
e266-e272
Gillespie, David
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Butler, Christopher C.
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Bates, Janine
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Hood, Kerenza
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Melbye, Hasse
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Phillips, Rhiannon
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Stanton, Helen
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Alam, Mohammed Fasihul
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Cals, Jochen Wl
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Cochrane, Ann
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Kirby, Nigel
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Llor, Carl
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Lowe, Rachel
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Naik, Gurudutt
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Riga, Evgenia
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Sewell, Bernadette
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Thomas-Jones, Emma
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White, Patrick
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Francis, Nick A.
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Gillespie, David
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Butler, Christopher C.
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Bates, Janine
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Hood, Kerenza
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Melbye, Hasse
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Phillips, Rhiannon
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Stanton, Helen
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Alam, Mohammed Fasihul
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Cals, Jochen Wl
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Cochrane, Ann
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Kirby, Nigel
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Llor, Carl
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Lowe, Rachel
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Naik, Gurudutt
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Riga, Evgenia
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Sewell, Bernadette
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Thomas-Jones, Emma
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White, Patrick
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Francis, Nick A.
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Gillespie, David, Butler, Christopher C., Bates, Janine, Hood, Kerenza, Melbye, Hasse, Phillips, Rhiannon, Stanton, Helen, Alam, Mohammed Fasihul, Cals, Jochen Wl, Cochrane, Ann, Kirby, Nigel, Llor, Carl, Lowe, Rachel, Naik, Gurudutt, Riga, Evgenia, Sewell, Bernadette, Thomas-Jones, Emma, White, Patrick and Francis, Nick A. (2021) Associations with antibiotic prescribing for acute exacerbation of COPD in primary care: secondary analysis of a randomised controlled trial. The British journal of general practice : the journal of the Royal College of General Practitioners, 71 (705), e266-e272. (doi:10.3399/BJGP.2020.0823).

Record type: Article

Abstract

Background C-reactive protein (CRP) point-of-care testing can reduce antibiotic use in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in primary care, without compromising patient care. Further safe reductions may be possible.

Aim To investigate the associations between presenting features and antibiotic prescribing in patients with AECOPD in primary care.

Design and setting Secondary analysis of a randomised controlled trial of participants presenting with AECOPD in primary care (the PACE trial).

Method Clinicians collected participants’ demographic features, comorbid illnesses, clinical signs, and symptoms. Antibiotic prescribing decisions were made after participants were randomised to receive a point-of-care CRP measurement or usual care. Multivariable regression models were fitted to explore the association between patient and clinical features and antibiotic prescribing, and extended to further explore any interactions with CRP measurement category (CRP not measured, CRP <20 mg/l, or CRP ≥20 mg/l).

Results A total of 649 participants from 86 general practices across England and Wales were included. Odds of antibiotic prescribing were higher in the presence of clinician-recorded crackles (adjusted odds ratio [AOR] = 5.22, 95% confidence interval [CI] = 3.24 to 8.41), wheeze (AOR = 1.64, 95% CI = 1.07 to 2.52), diminished vesicular breathing (AOR = 2.95, 95% CI = 1.70 to 5.10), or clinician-reported evidence of consolidation (AOR = 34.40, 95% CI = 2.84 to 417.27). Increased age was associated with lower odds of antibiotic prescribing (AOR per additional year increase = 0.98, 95% CI = 0.95 to 1.00), as was the presence of heart failure (AOR = 0.32, 95% CI = 0.12 to 0.85).

Conclusion Several demographic features and clinical signs and symptoms are associated with antibiotic prescribing in AECOPD. Diagnostic and prognostic value of these features may help identify further safe reductions.

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Submitted date: 7 September 2020
Accepted/In Press date: 23 November 2020
e-pub ahead of print date: 1 April 2021
Published date: 1 April 2021
Additional Information: Funding The study was supported by funds from the National Institute for Health Research (NIHR) Health Technology Assessment Programme (project number: 12/33/12).
Keywords: Antibiotics, C-reactive protein, COPD, Primary care, Randomised controlled trial

Identifiers

Local EPrints ID: 448900
URI: http://eprints.soton.ac.uk/id/eprint/448900
ISSN: 0960-1643
PURE UUID: 43e50750-b4cf-47eb-a863-aa87136bb1f9
ORCID for Nick A. Francis: ORCID iD orcid.org/0000-0001-8939-7312

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Date deposited: 10 May 2021 16:31
Last modified: 10 Jan 2022 03:19

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Contributors

Author: David Gillespie
Author: Christopher C. Butler
Author: Janine Bates
Author: Kerenza Hood
Author: Hasse Melbye
Author: Rhiannon Phillips
Author: Helen Stanton
Author: Mohammed Fasihul Alam
Author: Jochen Wl Cals
Author: Ann Cochrane
Author: Nigel Kirby
Author: Carl Llor
Author: Rachel Lowe
Author: Gurudutt Naik
Author: Evgenia Riga
Author: Bernadette Sewell
Author: Emma Thomas-Jones
Author: Patrick White
Author: Nick A. Francis ORCID iD

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