Predictors for antibiotic prescribing in patients with exacerbations of COPD in general practice

Carl Llor, Lars Bjerrum, Anders Munck, Malene P Hansen, Gloria Cristina Córdoba, Eva Lena Strandberg, Ingvar Ovhed, Ruta Radzeviciene, Josep M Cots, Anatoliy Reutskiy, Lidia Caballero

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Abstract

BACKGROUND: The aim of this study was to describe the antibiotic prescribing rate in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD), to analyse predictors for antibiotic prescribing and to explore the influence of the use C-reactive protein (CRP) rapid test.

METHODS: A cross-sectional study was carried out in January and February 2008 in primary care. General practitioners (GPs) from six countries (Denmark, Sweden, Lithuania, Russia, Spain and Argentina) registered all patients with AECOPD during a 3-week period. A multilevel logistic regression model was estimated using two hierarchical levels, (i) patients and (ii) physicians, and was used to analyse the association between antibiotic prescribing and potential predictors for antibiotic use: patients' age and gender, duration and symptoms and signs of exacerbations (fever, cough, dyspnoea, sputum volume and purulence) and the results of the CRP test.

RESULTS: A total of 617 GPs registered 1233 patients with AECOPD. A total of 970 patients (79%) were prescribed antibiotics, varying from 49% (Denmark) to 93% (Russia). The presence of purulent sputum was the strongest predictor for antibiotic treatment (odds ratio [OR] 8.7; 95% confidence interval [CI] 5.9-12.8). CRP determination was carried out mainly in Denmark and Sweden and its use was the strongest protective factor for antibiotic therapy (OR 0.3; 95% CI 0.2-0.6). GPs that used CRP testing weighted purulent sputum lower than GPs who did not use CRP testing. CRP values had a strong influence on the antibiotic prescribing rate.

CONCLUSIONS: Antibiotic treatment for AECOPD is very high. This study shows that GPs performing CRP rapid tests prescribe fewer antibiotics than those who do not.

Original languageEnglish
Pages (from-to)131-7
Number of pages7
JournalTherapeutic Advances in Respiratory Disease
Volume7
Issue number3
DOIs
Publication statusPublished - Jun 2013
Externally publishedYes

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General Practice
Chronic Obstructive Pulmonary Disease
Anti-Bacterial Agents
C-Reactive Protein
General Practitioners
Denmark
Sputum
Russia
Sweden
Logistic Models
Odds Ratio
Confidence Intervals
Lithuania
Argentina
Cough
Dyspnea
Spain
Signs and Symptoms
Primary Health Care
Fever

Cite this

Llor, C., Bjerrum, L., Munck, A., Hansen, M. P., Córdoba, G. C., Strandberg, E. L., ... Caballero, L. (2013). Predictors for antibiotic prescribing in patients with exacerbations of COPD in general practice. Therapeutic Advances in Respiratory Disease, 7(3), 131-7. https://doi.org/10.1177/1753465812472387
Llor, Carl ; Bjerrum, Lars ; Munck, Anders ; Hansen, Malene P ; Córdoba, Gloria Cristina ; Strandberg, Eva Lena ; Ovhed, Ingvar ; Radzeviciene, Ruta ; Cots, Josep M ; Reutskiy, Anatoliy ; Caballero, Lidia. / Predictors for antibiotic prescribing in patients with exacerbations of COPD in general practice. In: Therapeutic Advances in Respiratory Disease. 2013 ; Vol. 7, No. 3. pp. 131-7.
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abstract = "BACKGROUND: The aim of this study was to describe the antibiotic prescribing rate in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD), to analyse predictors for antibiotic prescribing and to explore the influence of the use C-reactive protein (CRP) rapid test.METHODS: A cross-sectional study was carried out in January and February 2008 in primary care. General practitioners (GPs) from six countries (Denmark, Sweden, Lithuania, Russia, Spain and Argentina) registered all patients with AECOPD during a 3-week period. A multilevel logistic regression model was estimated using two hierarchical levels, (i) patients and (ii) physicians, and was used to analyse the association between antibiotic prescribing and potential predictors for antibiotic use: patients' age and gender, duration and symptoms and signs of exacerbations (fever, cough, dyspnoea, sputum volume and purulence) and the results of the CRP test.RESULTS: A total of 617 GPs registered 1233 patients with AECOPD. A total of 970 patients (79{\%}) were prescribed antibiotics, varying from 49{\%} (Denmark) to 93{\%} (Russia). The presence of purulent sputum was the strongest predictor for antibiotic treatment (odds ratio [OR] 8.7; 95{\%} confidence interval [CI] 5.9-12.8). CRP determination was carried out mainly in Denmark and Sweden and its use was the strongest protective factor for antibiotic therapy (OR 0.3; 95{\%} CI 0.2-0.6). GPs that used CRP testing weighted purulent sputum lower than GPs who did not use CRP testing. CRP values had a strong influence on the antibiotic prescribing rate.CONCLUSIONS: Antibiotic treatment for AECOPD is very high. This study shows that GPs performing CRP rapid tests prescribe fewer antibiotics than those who do not.",
author = "Carl Llor and Lars Bjerrum and Anders Munck and Hansen, {Malene P} and C{\'o}rdoba, {Gloria Cristina} and Strandberg, {Eva Lena} and Ingvar Ovhed and Ruta Radzeviciene and Cots, {Josep M} and Anatoliy Reutskiy and Lidia Caballero",
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Llor, C, Bjerrum, L, Munck, A, Hansen, MP, Córdoba, GC, Strandberg, EL, Ovhed, I, Radzeviciene, R, Cots, JM, Reutskiy, A & Caballero, L 2013, 'Predictors for antibiotic prescribing in patients with exacerbations of COPD in general practice' Therapeutic Advances in Respiratory Disease, vol. 7, no. 3, pp. 131-7. https://doi.org/10.1177/1753465812472387

Predictors for antibiotic prescribing in patients with exacerbations of COPD in general practice. / Llor, Carl; Bjerrum, Lars; Munck, Anders; Hansen, Malene P; Córdoba, Gloria Cristina; Strandberg, Eva Lena; Ovhed, Ingvar; Radzeviciene, Ruta; Cots, Josep M; Reutskiy, Anatoliy; Caballero, Lidia.

In: Therapeutic Advances in Respiratory Disease, Vol. 7, No. 3, 06.2013, p. 131-7.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Predictors for antibiotic prescribing in patients with exacerbations of COPD in general practice

AU - Llor, Carl

AU - Bjerrum, Lars

AU - Munck, Anders

AU - Hansen, Malene P

AU - Córdoba, Gloria Cristina

AU - Strandberg, Eva Lena

AU - Ovhed, Ingvar

AU - Radzeviciene, Ruta

AU - Cots, Josep M

AU - Reutskiy, Anatoliy

AU - Caballero, Lidia

PY - 2013/6

Y1 - 2013/6

N2 - BACKGROUND: The aim of this study was to describe the antibiotic prescribing rate in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD), to analyse predictors for antibiotic prescribing and to explore the influence of the use C-reactive protein (CRP) rapid test.METHODS: A cross-sectional study was carried out in January and February 2008 in primary care. General practitioners (GPs) from six countries (Denmark, Sweden, Lithuania, Russia, Spain and Argentina) registered all patients with AECOPD during a 3-week period. A multilevel logistic regression model was estimated using two hierarchical levels, (i) patients and (ii) physicians, and was used to analyse the association between antibiotic prescribing and potential predictors for antibiotic use: patients' age and gender, duration and symptoms and signs of exacerbations (fever, cough, dyspnoea, sputum volume and purulence) and the results of the CRP test.RESULTS: A total of 617 GPs registered 1233 patients with AECOPD. A total of 970 patients (79%) were prescribed antibiotics, varying from 49% (Denmark) to 93% (Russia). The presence of purulent sputum was the strongest predictor for antibiotic treatment (odds ratio [OR] 8.7; 95% confidence interval [CI] 5.9-12.8). CRP determination was carried out mainly in Denmark and Sweden and its use was the strongest protective factor for antibiotic therapy (OR 0.3; 95% CI 0.2-0.6). GPs that used CRP testing weighted purulent sputum lower than GPs who did not use CRP testing. CRP values had a strong influence on the antibiotic prescribing rate.CONCLUSIONS: Antibiotic treatment for AECOPD is very high. This study shows that GPs performing CRP rapid tests prescribe fewer antibiotics than those who do not.

AB - BACKGROUND: The aim of this study was to describe the antibiotic prescribing rate in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD), to analyse predictors for antibiotic prescribing and to explore the influence of the use C-reactive protein (CRP) rapid test.METHODS: A cross-sectional study was carried out in January and February 2008 in primary care. General practitioners (GPs) from six countries (Denmark, Sweden, Lithuania, Russia, Spain and Argentina) registered all patients with AECOPD during a 3-week period. A multilevel logistic regression model was estimated using two hierarchical levels, (i) patients and (ii) physicians, and was used to analyse the association between antibiotic prescribing and potential predictors for antibiotic use: patients' age and gender, duration and symptoms and signs of exacerbations (fever, cough, dyspnoea, sputum volume and purulence) and the results of the CRP test.RESULTS: A total of 617 GPs registered 1233 patients with AECOPD. A total of 970 patients (79%) were prescribed antibiotics, varying from 49% (Denmark) to 93% (Russia). The presence of purulent sputum was the strongest predictor for antibiotic treatment (odds ratio [OR] 8.7; 95% confidence interval [CI] 5.9-12.8). CRP determination was carried out mainly in Denmark and Sweden and its use was the strongest protective factor for antibiotic therapy (OR 0.3; 95% CI 0.2-0.6). GPs that used CRP testing weighted purulent sputum lower than GPs who did not use CRP testing. CRP values had a strong influence on the antibiotic prescribing rate.CONCLUSIONS: Antibiotic treatment for AECOPD is very high. This study shows that GPs performing CRP rapid tests prescribe fewer antibiotics than those who do not.

U2 - 10.1177/1753465812472387

DO - 10.1177/1753465812472387

M3 - Article

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EP - 137

JO - Therapeutic Advances in Respiratory Disease

JF - Therapeutic Advances in Respiratory Disease

SN - 1753-4658

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ER -