[Infection and antibiotic use in COPD in primary care]

The aim of this study was to know the opinion of Spanish primary care physicians regarding various aspects of diagnosis and treatment of chronic obstructive pulmonary disease (COPD), particularly with regard to bacterial infection in COPD.

A 20-item questionnaire about diagnostic and therapeutic aspects of COPD was distributed to 15,000 primary care physicians. The sample was stratified to be representative of Spanish geographic areas. Participation was voluntary and no incentive was provided; assurance of confidentiality of information given. A specially designed program was used for data analysis.

Valid responses were obtained from 1,852 physicians (12.3%), 86% of whom were practicing in public clinics. Increased coughing with mucopurulent expectoration was considered the most important sign leading to suspicion of respiratory infection according to 70% of the respondents. The germs that primary care physicians thought responsible for infection in most cases were H. influenzae (83%), S. pneumoniae (79%), Pseudomonas (65%) and M. catarrhalis (61%). Antimicrobial spectrum was considered the main criterion for choosing an antibiotic (by 91%). The most frequently prescribed antibiotics were by order of preference: amoxicillin-clavulanic (50%), macrolides (24%), second and third generation cephalosporins (15%) and others. Mean duration of treatment was seen to be 10 days in nearly all cases.

The primary care physicians surveyed were shown to have a good level of understanding of bacterial infection and its treatment in COPD.