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Inappropriate Utilization of Antibiotics in COPD Exacerbations
Yelda Varol1, Zuhal Karakurt2, Ali Kadri Çırak1
1Department of Pulmonology, University of Health Sciences, Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital, İzmir, Turkey.
Objective:
Most exacerbations are mild to moderate, and antibiotic treatment for acute exacerbations of chronic obstructive pulmonary disease (AECOPD) is recommended for patients with severe exacerbations or severe underlying chronic obstructive pulmonary disease (COPD). Therefore, we aimed to investigate the patient factors that are associated with the prescription of antibiotics for inappropriate indication in AECOPD.
Material And Methods:
This study was an observational cross-sectional study conducted in an outpatient clinic. The patients diagnosed with AECOPD and prescribed an antibiotic by a pulmonary physician were enrolled in the study. These prescriptions were documented by the pharmacist who asked the patient about the three cardinal symptoms. Appropriate and inappropriate prescription groups were defined by the types of exacerbations, as defined by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) COPD report.
Results:
There were 138 patients, predominantly male (83%), with a mean age of 64 (±9) years. A total of 64% of the prescriptions were appropriate; however, there were 50 (36%) patients with inappropriate antibiotic prescription according to the mentioned criteria. When we compared the patient factors between the appropriate and inappropriate antibiotic prescriptions, there was no statistically significant difference in terms of age, Forced expiratory volume in first second % (FEV1%) predicted, FEV1 ml, forced vital capacity (FVC) ml, FEV1/FVC, and amount (packs/year) of smoking (p>0.05 for all parameters). FVC% was statistically significantly lower in the appropriate antibiotic prescription group compared with that in the inappropriate antibiotic prescription group (p=0.049).
Conclusion:
This study shows that most pulmonary physicians have a tendency to prescribe antibiotics for AECOPD according to the defined GOLD criteria. However, some of the physicians also prefer to prescribe antibiotics self-directedly, irrespective of the GOLD criteria. A physician-based questionnaire can be completed for future studies to define the underlying reasons for antibiotic prescription demands for cases of mild AECOPD.
Insights
Antibiotic prescribing for acute exacerbations of chronic obstructive pulmonary disease (AECOPD) is often appropriate, but 36% of prescriptions were not indicated. Patient factors like age or smoking history did not predict inappropriate antibiotic use in AECOPD.
Area of Science:
- Pulmonary Medicine
- Infectious Disease
- Pharmacology
Background:
- Antibiotics are recommended for severe acute exacerbations of chronic obstructive pulmonary disease (AECOPD) or severe underlying COPD.
- Most exacerbations are mild to moderate, necessitating careful antibiotic prescription.
Purpose of the Study:
- To investigate patient factors associated with inappropriate antibiotic prescribing for AECOPD.
- To evaluate adherence to Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines in AECOPD antibiotic prescriptions.
Main Methods:
- An observational, cross-sectional study of AECOPD patients prescribed antibiotics in an outpatient setting.
- Prescriptions were assessed for appropriateness based on GOLD COPD report criteria.
- Patient data included demographics, spirometry (FEV1%, FVC%), and smoking history.
Main Results:
- Of 138 patients, 36% received inappropriate antibiotic prescriptions for AECOPD.
- No significant differences in age, FEV1, FVC, or smoking pack-years were found between appropriate and inappropriate groups.
- Lower FVC% was statistically associated with appropriate antibiotic prescription (p=0.049).
Conclusions:
- While most physicians follow GOLD criteria for AECOPD antibiotic prescribing, some self-direct prescriptions.
- Further research using physician questionnaires is needed to understand reasons for non-adherence in mild AECOPD cases.
- Optimizing antibiotic use in AECOPD requires understanding physician prescribing behaviors.
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