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

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

doi:10.3399/BJGP.2020.0823

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

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

Health Sciences

Research output: Contribution to journal › Article › peer-review

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. Keywords antibiotics; COPD; C-reactive protein; primarycare; randomised controlled trial.

Original language	English
Pages (from-to)	e266-e272
Number of pages	7
Journal	British Journal of General Practice
Volume	71
Issue number	705
Early online date	8 Mar 2021
DOIs	https://doi.org/10.3399/BJGP.2020.0823
Publication status	Published - 1 Apr 2021

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Gillespie, D., Butler, C. C., Bates, J., Hood, K., Melbye, H., Phillips, R., Stanton, H., Alam, M. F., Cals, J. WL., Cochrane, A., Kirby, N., Llor, C., Lowe, R., Naik, G., Riga, E., Sewell, B., Thomas-Jones, E., White, P., & Francis, N. A. (2021). Associations with antibiotic prescribing for acute exacerbation of COPD in primary care: secondary analysis of a randomised controlled trial. British Journal of General Practice, 71(705), e266-e272. https://doi.org/10.3399/BJGP.2020.0823

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

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{\textquoteright} 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. Keywords antibiotics; COPD; C-reactive protein; primarycare; randomised controlled trial. ",

author = "David Gillespie and Butler, {Christopher C} and Janine Bates and Kerenza Hood and Hasse Melbye and Rhiannon Phillips and Helen Stanton and Alam, {Mohammed Fasihul} and Cals, {Jochen WL} and Ann Cochrane and Nigel Kirby and Carl Llor and Rachel Lowe and Gurudutt Naik and Evgenia Riga and Bernadette Sewell and Emma Thomas-Jones and Patrick White and Francis, {Nick A}",

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doi = "10.3399/BJGP.2020.0823",

language = "English",

volume = "71",

pages = "e266--e272",

journal = "British Journal of General Practice",

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publisher = "Royal College of General Practitioners",

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Gillespie, D, Butler, CC, Bates, J, Hood, K, Melbye, H, Phillips, R, Stanton, H, Alam, MF, Cals, JWL, Cochrane, A, Kirby, N, Llor, C, Lowe, R, Naik, G, Riga, E, Sewell, B, Thomas-Jones, E, White, P & Francis, NA 2021, 'Associations with antibiotic prescribing for acute exacerbation of COPD in primary care: secondary analysis of a randomised controlled trial', British Journal of General Practice, vol. 71, no. 705, pp. e266-e272. https://doi.org/10.3399/BJGP.2020.0823

TY - JOUR

T1 - Associations with antibiotic prescribing for acute exacerbation of COPD in primary care

T2 - secondary analysis of a randomised controlled trial

AU - Gillespie, David

AU - Butler, Christopher C

AU - Bates, Janine

AU - Hood, Kerenza

AU - Melbye, Hasse

AU - Phillips, Rhiannon

AU - Stanton, Helen

AU - Alam, Mohammed Fasihul

AU - Cals, Jochen WL

AU - Cochrane, Ann

AU - Kirby, Nigel

AU - Llor, Carl

AU - Lowe, Rachel

AU - Naik, Gurudutt

AU - Riga, Evgenia

AU - Sewell, Bernadette

AU - Thomas-Jones, Emma

AU - White, Patrick

AU - Francis, Nick A

PY - 2021/4/1

Y1 - 2021/4/1

N2 - 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. Keywords antibiotics; COPD; C-reactive protein; primarycare; randomised controlled trial.

AB - 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. Keywords antibiotics; COPD; C-reactive protein; primarycare; randomised controlled trial.

U2 - 10.3399/BJGP.2020.0823

DO - 10.3399/BJGP.2020.0823

M3 - Article

SN - 0960-1643

VL - 71

SP - e266-e272

JO - British Journal of General Practice

JF - British Journal of General Practice

IS - 705

ER -