Associations with antibiotic prescribing for acute exacerbation of COPD in primary care: secondary analysis of a randomised controlled trial

David Gillespie; Christopher C. Butler; Janine Bates; Kerenza Hood; Hasse Melbye; Rhiannon Phillips; Helen Stanton; Mohammed Fasihul Alam; Jochen Wl Cals; Ann Cochrane; Nigel Kirby; Carl Llor; Rachel Lowe; Gurudutt Naik; Evgenia Riga; Bernadette Sewell; Emma Thomas-Jones; Patrick White; Nick A. Francis

doi:10.3399/BJGP.2020.0823

Associations with antibiotic prescribing for acute exacerbation of COPD in primary care: secondary analysis of a randomised controlled trial

David Gillespie, Christopher C. Butler, Janine Bates, Kerenza Hood, Hasse Melbye, Rhiannon Phillips, Helen Stanton, Mohammed Fasihul Alam, Jochen Wl Cals, Ann Cochrane, Nigel Kirby, Carl Llor, Rachel Lowe, Gurudutt Naik, Evgenia Riga, Bernadette Sewell, Emma Thomas-Jones, Patrick White, Nick A. Francis

Population Health Sciences

Research output: Contribution to journal › Article › peer-review

6 Citations (Scopus)

Abstract

BACKGROUND: C-reactive protein (CRP) point-of-care testing can reduce antibiotic use in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in primary care, without compromising patient care. Further safe reductions may be possible. AIM: To investigate the associations between presenting features and antibiotic prescribing in patients with AECOPD in primary care. DESIGN AND SETTING: Secondary analysis of a randomised controlled trial of participants presenting with AECOPD in primary care (the PACE trial). METHOD: Clinicians collected participants' demographic features, comorbid illnesses, clinical signs, and symptoms. Antibiotic prescribing decisions were made after participants were randomised to receive a point-of-care CRP measurement or usual care. Multivariable regression models were fitted to explore the association between patient and clinical features and antibiotic prescribing, and extended to further explore any interactions with CRP measurement category (CRP not measured, CRP <20 mg/l, or CRP ≥20 mg/l). RESULTS: A total of 649 participants from 86 general practices across England and Wales were included. Odds of antibiotic prescribing were higher in the presence of clinician-recorded crackles (adjusted odds ratio [AOR] = 5.22, 95% confidence interval [CI] = 3.24 to 8.41), wheeze (AOR = 1.64, 95% CI = 1.07 to 2.52), diminished vesicular breathing (AOR = 2.95, 95% CI = 1.70 to 5.10), or clinician-reported evidence of consolidation (AOR = 34.40, 95% CI = 2.84 to 417.27). Increased age was associated with lower odds of antibiotic prescribing (AOR per additional year increase = 0.98, 95% CI = 0.95 to 1.00), as was the presence of heart failure (AOR = 0.32, 95% CI = 0.12 to 0.85). CONCLUSION: Several demographic features and clinical signs and symptoms are associated with antibiotic prescribing in AECOPD. Diagnostic and prognostic value of these features may help identify further safe reductions.

Original language	English
Pages (from-to)	e266-e272
Journal	The British journal of general practice : the journal of the Royal College of General Practitioners
Volume	71
Issue number	705
DOIs	https://doi.org/10.3399/BJGP.2020.0823
Publication status	Published - 1 Apr 2021

Keywords

antibiotics
C-reactive protein
COPD
primary care
randomised controlled trial

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10.3399/BJGP.2020.0823

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Gillespie, D., Butler, C. C., Bates, J., Hood, K., Melbye, H., Phillips, R., Stanton, H., Alam, M. F., Cals, J. W., Cochrane, A., Kirby, N., Llor, C., Lowe, R., Naik, G., Riga, E., Sewell, B., Thomas-Jones, E., White, P., & Francis, N. A. (2021). Associations with antibiotic prescribing for acute exacerbation of COPD in primary care: secondary analysis of a randomised controlled trial. The British journal of general practice : the journal of the Royal College of General Practitioners, 71(705), e266-e272. https://doi.org/10.3399/BJGP.2020.0823

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title = "Associations with antibiotic prescribing for acute exacerbation of COPD in primary care: secondary analysis of a randomised controlled trial",

abstract = "BACKGROUND: C-reactive protein (CRP) point-of-care testing can reduce antibiotic use in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in primary care, without compromising patient care. Further safe reductions may be possible. AIM: To investigate the associations between presenting features and antibiotic prescribing in patients with AECOPD in primary care. DESIGN AND SETTING: Secondary analysis of a randomised controlled trial of participants presenting with AECOPD in primary care (the PACE trial). METHOD: Clinicians collected participants' demographic features, comorbid illnesses, clinical signs, and symptoms. Antibiotic prescribing decisions were made after participants were randomised to receive a point-of-care CRP measurement or usual care. Multivariable regression models were fitted to explore the association between patient and clinical features and antibiotic prescribing, and extended to further explore any interactions with CRP measurement category (CRP not measured, CRP <20 mg/l, or CRP ≥20 mg/l). RESULTS: A total of 649 participants from 86 general practices across England and Wales were included. Odds of antibiotic prescribing were higher in the presence of clinician-recorded crackles (adjusted odds ratio [AOR] = 5.22, 95% confidence interval [CI] = 3.24 to 8.41), wheeze (AOR = 1.64, 95% CI = 1.07 to 2.52), diminished vesicular breathing (AOR = 2.95, 95% CI = 1.70 to 5.10), or clinician-reported evidence of consolidation (AOR = 34.40, 95% CI = 2.84 to 417.27). Increased age was associated with lower odds of antibiotic prescribing (AOR per additional year increase = 0.98, 95% CI = 0.95 to 1.00), as was the presence of heart failure (AOR = 0.32, 95% CI = 0.12 to 0.85). CONCLUSION: Several demographic features and clinical signs and symptoms are associated with antibiotic prescribing in AECOPD. Diagnostic and prognostic value of these features may help identify further safe reductions.",

keywords = "antibiotics, C-reactive protein, COPD, primary care, randomised controlled trial",

author = "David Gillespie and Butler, {Christopher C.} and Janine Bates and Kerenza Hood and Hasse Melbye and Rhiannon Phillips and Helen Stanton and Alam, {Mohammed Fasihul} and Cals, {Jochen Wl} and Ann Cochrane and Nigel Kirby and Carl Llor and Rachel Lowe and Gurudutt Naik and Evgenia Riga and Bernadette Sewell and Emma Thomas-Jones and Patrick White and Francis, {Nick A.}",

note = "Funding Information: The study was supported by funds from the National Institute for Health Research (NIHR) Health Technology Assessment Programme (project number: 12/33/12). Funding Information: David Gillespie, Ann Cochrane, Bernadette Sewell, Emma Thomas-Jones, Gurudutt Naik, Helen Stanton, Janine Bates, Evgenia Riga, Kerenza Hood, Nigel Kirby, Patrick White, Rachel Lowe, Rhiannon Phillips, and Nick A Francis report grants from NIHR, during the conduct of the study. Christopher C Butler reports grants from NIHR, NIHR Health Technology Assessment Programme, NIHR Health Protection Research Unit on Health Care Associated Infections and Antimicrobial Resistance, and NIHR Community Healthcare MedTech and In Vitro Diagnostics Cooperative. Afinion C-reactive protein (CRP) devices and associated training to participating general practices were provided at no cost to the study by Alere; and is part of publicly funded research consortia that include industrial partners. All other authors have declared no competing interests. Data sharing Data available from the authors on request. Acknowledgements The authors would like to thank the patients who participated in the trial and their families, without whom this study would not have been possible. Thanks also to the contribution of other members of the PACE trial team (Angela Watkins, Christy Barlow, Deborah Fitzsimmons, and Micaela Gal). Jacqueline Nuttall provided study design input. Publisher Copyright: {\textcopyright} The Authors. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.",

year = "2021",

month = apr,

day = "1",

doi = "10.3399/BJGP.2020.0823",

language = "English",

volume = "71",

pages = "e266--e272",

journal = "The British journal of general practice : the journal of the Royal College of General Practitioners",

issn = "0960-1643",

publisher = "ROYAL COLL GENERAL PRACTITIONERS",

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Gillespie, D, Butler, CC, Bates, J, Hood, K, Melbye, H, Phillips, R, Stanton, H, Alam, MF, Cals, JW, Cochrane, A, Kirby, N, Llor, C, Lowe, R, Naik, G, Riga, E, Sewell, B, Thomas-Jones, E, White, P & Francis, NA 2021, 'Associations with antibiotic prescribing for acute exacerbation of COPD in primary care: secondary analysis of a randomised controlled trial', The British journal of general practice : the journal of the Royal College of General Practitioners, vol. 71, no. 705, pp. e266-e272. https://doi.org/10.3399/BJGP.2020.0823

Associations with antibiotic prescribing for acute exacerbation of COPD in primary care: secondary analysis of a randomised controlled trial. / Gillespie, David; Butler, Christopher C.; Bates, Janine et al.
In: The British journal of general practice : the journal of the Royal College of General Practitioners, Vol. 71, No. 705, 01.04.2021, p. e266-e272.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Associations with antibiotic prescribing for acute exacerbation of COPD in primary care

T2 - secondary analysis of a randomised controlled trial

AU - Gillespie, David

AU - Butler, Christopher C.

AU - Bates, Janine

AU - Hood, Kerenza

AU - Melbye, Hasse

AU - Phillips, Rhiannon

AU - Stanton, Helen

AU - Alam, Mohammed Fasihul

AU - Cals, Jochen Wl

AU - Cochrane, Ann

AU - Kirby, Nigel

AU - Llor, Carl

AU - Lowe, Rachel

AU - Naik, Gurudutt

AU - Riga, Evgenia

AU - Sewell, Bernadette

AU - Thomas-Jones, Emma

AU - White, Patrick

AU - Francis, Nick A.

N1 - Funding Information: The study was supported by funds from the National Institute for Health Research (NIHR) Health Technology Assessment Programme (project number: 12/33/12). Funding Information: David Gillespie, Ann Cochrane, Bernadette Sewell, Emma Thomas-Jones, Gurudutt Naik, Helen Stanton, Janine Bates, Evgenia Riga, Kerenza Hood, Nigel Kirby, Patrick White, Rachel Lowe, Rhiannon Phillips, and Nick A Francis report grants from NIHR, during the conduct of the study. Christopher C Butler reports grants from NIHR, NIHR Health Technology Assessment Programme, NIHR Health Protection Research Unit on Health Care Associated Infections and Antimicrobial Resistance, and NIHR Community Healthcare MedTech and In Vitro Diagnostics Cooperative. Afinion C-reactive protein (CRP) devices and associated training to participating general practices were provided at no cost to the study by Alere; and is part of publicly funded research consortia that include industrial partners. All other authors have declared no competing interests. Data sharing Data available from the authors on request. Acknowledgements The authors would like to thank the patients who participated in the trial and their families, without whom this study would not have been possible. Thanks also to the contribution of other members of the PACE trial team (Angela Watkins, Christy Barlow, Deborah Fitzsimmons, and Micaela Gal). Jacqueline Nuttall provided study design input. Publisher Copyright: © The Authors. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

PY - 2021/4/1

Y1 - 2021/4/1

N2 - BACKGROUND: C-reactive protein (CRP) point-of-care testing can reduce antibiotic use in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in primary care, without compromising patient care. Further safe reductions may be possible. AIM: To investigate the associations between presenting features and antibiotic prescribing in patients with AECOPD in primary care. DESIGN AND SETTING: Secondary analysis of a randomised controlled trial of participants presenting with AECOPD in primary care (the PACE trial). METHOD: Clinicians collected participants' demographic features, comorbid illnesses, clinical signs, and symptoms. Antibiotic prescribing decisions were made after participants were randomised to receive a point-of-care CRP measurement or usual care. Multivariable regression models were fitted to explore the association between patient and clinical features and antibiotic prescribing, and extended to further explore any interactions with CRP measurement category (CRP not measured, CRP <20 mg/l, or CRP ≥20 mg/l). RESULTS: A total of 649 participants from 86 general practices across England and Wales were included. Odds of antibiotic prescribing were higher in the presence of clinician-recorded crackles (adjusted odds ratio [AOR] = 5.22, 95% confidence interval [CI] = 3.24 to 8.41), wheeze (AOR = 1.64, 95% CI = 1.07 to 2.52), diminished vesicular breathing (AOR = 2.95, 95% CI = 1.70 to 5.10), or clinician-reported evidence of consolidation (AOR = 34.40, 95% CI = 2.84 to 417.27). Increased age was associated with lower odds of antibiotic prescribing (AOR per additional year increase = 0.98, 95% CI = 0.95 to 1.00), as was the presence of heart failure (AOR = 0.32, 95% CI = 0.12 to 0.85). CONCLUSION: Several demographic features and clinical signs and symptoms are associated with antibiotic prescribing in AECOPD. Diagnostic and prognostic value of these features may help identify further safe reductions.

AB - BACKGROUND: C-reactive protein (CRP) point-of-care testing can reduce antibiotic use in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in primary care, without compromising patient care. Further safe reductions may be possible. AIM: To investigate the associations between presenting features and antibiotic prescribing in patients with AECOPD in primary care. DESIGN AND SETTING: Secondary analysis of a randomised controlled trial of participants presenting with AECOPD in primary care (the PACE trial). METHOD: Clinicians collected participants' demographic features, comorbid illnesses, clinical signs, and symptoms. Antibiotic prescribing decisions were made after participants were randomised to receive a point-of-care CRP measurement or usual care. Multivariable regression models were fitted to explore the association between patient and clinical features and antibiotic prescribing, and extended to further explore any interactions with CRP measurement category (CRP not measured, CRP <20 mg/l, or CRP ≥20 mg/l). RESULTS: A total of 649 participants from 86 general practices across England and Wales were included. Odds of antibiotic prescribing were higher in the presence of clinician-recorded crackles (adjusted odds ratio [AOR] = 5.22, 95% confidence interval [CI] = 3.24 to 8.41), wheeze (AOR = 1.64, 95% CI = 1.07 to 2.52), diminished vesicular breathing (AOR = 2.95, 95% CI = 1.70 to 5.10), or clinician-reported evidence of consolidation (AOR = 34.40, 95% CI = 2.84 to 417.27). Increased age was associated with lower odds of antibiotic prescribing (AOR per additional year increase = 0.98, 95% CI = 0.95 to 1.00), as was the presence of heart failure (AOR = 0.32, 95% CI = 0.12 to 0.85). CONCLUSION: Several demographic features and clinical signs and symptoms are associated with antibiotic prescribing in AECOPD. Diagnostic and prognostic value of these features may help identify further safe reductions.

KW - antibiotics

KW - C-reactive protein

KW - COPD

KW - primary care

KW - randomised controlled trial

UR - http://www.scopus.com/inward/record.url?scp=85103608200&partnerID=8YFLogxK

U2 - 10.3399/BJGP.2020.0823

DO - 10.3399/BJGP.2020.0823

M3 - Article

C2 - 33657007

AN - SCOPUS:85103608200

SN - 0960-1643

VL - 71

SP - e266-e272

JO - The British journal of general practice : the journal of the Royal College of General Practitioners

JF - The British journal of general practice : the journal of the Royal College of General Practitioners

IS - 705

ER -

Associations with antibiotic prescribing for acute exacerbation of COPD in primary care: secondary analysis of a randomised controlled trial

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