| アブストラクト | BACKGROUND: In primary care there is uncertainty about which patients with acute exacerbations of COPD (AECOPD) benefit from antibiotics. OBJECTIVES: To identify which types of COPD patients get the most antibiotics in primary care to support targeted antibiotic stewardship. METHODS: Observational study of COPD patients using a large English primary care database with 12 month follow-up. We estimated the incidence of and risk factors for antibiotic prescribing relative to the number of AECOPD during follow-up, considering COPD severity, smoking, obesity and comorbidity. RESULTS: From 157 practices, 19594 patients were diagnosed with COPD, representing 2.6% of patients and 11.5% of all prescribed antibiotics. Eight hundred and thirty-three (4.5%) patients with severe COPD and frequent AECOPD were prescribed six to nine prescriptions per year and accounted for 13.0% of antibiotics. Individuals with mild to moderate COPD and zero or one AECOPD received one to three prescriptions per year but accounted for 42.5% of all prescriptions. In addition to COPD severity, asthma, chronic heart disease, diabetes, heart failure and influenza vaccination were independently associated with increased antibiotic use. CONCLUSIONS: Patients with severe COPD have the highest rates of antibiotic prescribing but most antibiotics are prescribed for patients with mild to moderate COPD. Antibiotic stewardship should focus on the dual goals of safely reducing the volume of prescribing in patients with mild to moderate COPD, and optimizing prescribing in patients with severe disease who are at significant risk of drug resistance. |
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| ジャーナル名 | The Journal of antimicrobial chemotherapy |
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| 投稿日 | 2019/10/11 |
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| 投稿者 | Rockenschaub, Patrick; Jhass, Arnoupe; Freemantle, Nick; Aryee, Anna; Rafiq, Meena; Hayward, Andrew; Shallcross, Laura |
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| 組織名 | Institute of Health Informatics, University College London, 222 Euston Rd, London;NW1 2DA, UK.;Primary Care & Population Health, University College London, Rowland Hill Street,;London NW3 2PF, UK.;Institute of Clinical Trials and Methodology, University College London, 90 High;Holborn, London WC1V 6LJ, UK.;Institute of Epidemiology & Healthcare, University College London, 1-19;Torrington Place, London WC1E 7HB, UK. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/31598669/ |
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