Antibiotic choice and repeat prescriptions in infective COPD exacerbations

Abstract

Background: Antibiotics are routinely given to COPD patients presenting with lower respiratory tract infection (LRTI) symptoms in primary care. Yet the optimal drug and duration for effective first line treatment is unclear. Aim: To characterise antibiotic prescriptions for LRTI in COPD patients and investigate factors associated with repeat prescriptions. Methods: A retrospective analysis of antibiotic prescriptions for non-pneumonic LRTI in COPD patients from 2010 to 2015 using the UK primary care Optimum Patient Care Research Database. Second antibiotic prescriptions for LRTI or all indications within 14 days were the primary and secondary outcomes respectively, a proxy of initial treatment failure. We derived a model for repeat courses using uni- and multivariable logistic regression analysis. Results: 8.4% of the 9,042 incident events received further antibiotics for LRTI, 15.5% further courses for any indication. Amoxicillin and doxycycline were the commonest index and second line drugs respectively (58.7% and 28.7%), mostly given for 7 days. Index drugs other than amoxicillin, cardiovascular disease, pneumococcal vaccination and more primary care consultations were significantly associated with repeat prescriptions for LRTI (p Conclusion: Almost one in twelve patients received two antibiotic courses for LRTI within two weeks. There was no consensus antibiotic strategy. The data supported the preference for amoxicillin as index drug but confirmation by interventional methods is needed.