1 Department of Public Health, Department of Public Health, Faculty of Health and Medical Sciences, Københavns Universitet2 Section of General Practice, Department of Public Health, Faculty of Health and Medical Sciences, Københavns Universitet3 Forskningsenheden for Almen Praksis, Eksterne centre, Københavns Universitet4 Department of Public Health, Faculty of Health and Medical Sciences, Københavns Universitet5 unknown6 Department of Civil Engineering7 Section of General Practice, Department of Public Health, Faculty of Health and Medical Sciences, Københavns Universitet
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.
Therapeutic Advances in Respiratory Disease, 2013, Vol 7, Issue 3, p. 131-137
Aged; Aged, 80 and over; Anti-Bacterial Agents; C-Reactive Protein; Cross-Sectional Studies; Female; General Practitioners; Humans; Logistic Models; Male; Middle Aged; Physician's Practice Patterns; Primary Health Care; Pulmonary Disease, Chronic Obstructive; Sputum