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AuthorGillespie, David
AuthorButler, Christopher C
AuthorBates, Janine
AuthorHood, Kerenza
AuthorMelbye, Hasse
AuthorPhillips, Rhiannon
AuthorStanton, Helen
AuthorAlam, Mohammed Fasihul
AuthorCals, Jochen Wl
AuthorCochrane, Ann
AuthorKirby, Nigel
AuthorLlor, Carl
AuthorLowe, Rachel
AuthorNaik, Gurudutt
AuthorRiga, Evgenia
AuthorSewell, Bernadette
AuthorThomas-Jones, Emma
AuthorWhite, Patrick
AuthorFrancis, Nick A
Available date2021-03-21T05:21:38Z
Publication Date2021-03-01
Publication NameBritish Journal of General Practice (BJGP)
Identifierhttp://dx.doi.org/10.3399/BJGP.2020.0823
CitationGillespie, 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; Francis, Nick A. Associations with antibiotic prescribing for acute exacerbation of COPD in primary care: secondary analysis of a randomised controlled trial, British Journal of General Practice 8 March 2021; BJGP.2020.0823. DOI: https://doi.org/10.3399/BJGP.2020.0823
ISSN0960-1643
URIhttp://hdl.handle.net/10576/17935
AbstractC-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. To investigate the associations between presenting features and antibiotic prescribing in patients with AECOPD in primary care. Secondary analysis of a randomised controlled trial of participants presenting with AECOPD in primary care (the PACE trial). 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). 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). 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.
SponsorThe study was supported by funds from the National Institute for Health Research (NIHR) Health Technology Assessment Programme (project number: 12/33/12).
Languageen
PublisherRoyal College of General Practitioners
SubjectC-reactive protein
COPD
antibiotics
primary care
randomised controlled trial
TitleAssociations with antibiotic prescribing for acute exacerbation of COPD in primary care: secondary analysis of a randomised controlled trial.
TypeArticle
ESSN1478-5242
dc.accessType Open Access


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