Work by IHI researchers explores opportunities to reduce antibiotic prescribing for COPD patients

In primary care there is uncertainty about which patients with chronic diseases benefit from antibiotics. Patients with COPD get three times more antibiotics than the general population but antibiotic treatment brings both risks and benefits for patients when they experience acute exacerbations. Reducing inappropriate antibiotic prescribing is a global priority to curb the emergence of antimicrobial resistance. However, despite only around half of acute COPD exacerbations being bacterially mediated, doctors have limited information in a primary care setting and delaying antibiotics could cause a COPD exacerbation so antibiotics are over prescribed.

A group of researchers led by Patrick Rockenshaub, a PhD student at the UCL IHI, carried out an observational study of COPD patients using a large English primary care database with 12 month follow-up.

The group showed that COPD patients received more than 10% of all prescribed antibiotics in 2015. Even low-severity patients with COPD had relatively high levels of prescribing of 1-3 antibiotics per year. On the other end of the spectrum, patients with very severe COPD received up to 6-9 prescriptions per year. Tailoring stewardship interventions such as the use of rapid diagnostic (C-reactive protein) tests to COPD severity and risk of complications might offer an opportunity to safely reduce exposure to antibiotics. However, changing prescribing practice is challenging, as COPD patients often expect antibiotic treatment, and clinicians are keen to avoid triggering exacerbations by delaying antibiotics.

Quantifying the harms of unnecessary antibiotic use in patients with chronic disease, as well as the benefits could help clinicians balance prescribing decisions.

To read the full paper visit the Journal of Antimicrobial Chemotherapy’s website: https://academic.oup.com/jac/advance-article/doi/10.1093/jac/dkz411/5584403

The paper’s full citation is: Patrick Rockenschaub, Arnoupe Jhass, Nick Freemantle, Anna Aryee, Meena Rafiq, Andrew Hayward, Laura Shallcross, Opportunities to reduce antibiotic prescribing for patients with COPD in primary care: a cohort study using electronic health records from the Clinical Practice Research Datalink (CPRD), Journal of Antimicrobial Chemotherapy, https://doi.org/10.1093/jac/dkz411