Researchers Suggest Reduction, Optimization of Antibiotic Prescriptions to Limit Drug Resistance Risk for Patients With Mild to Moderate COPD

For those with mild to moderate chronic obstructive pulmonary disease (COPD), researchers suggest that antibiotic stewardship focus on reducing and optimizing antibiotic use in patients with severe COPD who have a significant risk of drug resistance, according to October study findings published in the Journal of Antimicrobial Chemotherapy.

In 2015, patients with COPD accounted for 11.5% of all antibiotics prescribed, despite being only 2.6% of represented patients in primary care. Compared to those with severe COPD, patients with mild to moderate COPD use fewer antibiotics, however, they make up the majority of patients with COPD.

To find the most effective method of reducing antibiotic use, researchers examined antibiotic prescription statistics to find the optimal target group:

• Study composed of 157 practices, totaling 19,594 patients who were diagnosed with COPD. This represented 2.6% of all patients
• Data was collected using an English primary Care database with a 12-month follow-up
• Patients included were between 35 to 110 years old

Researchers found that patients with severe COPD were prescribed 6 to 9 prescriptions per year, accounting for 13% of antibiotics prescribed. This is in contrast to those with mild to severe COPD, who received 1 to 3 prescriptions per year but accounted for 42.5% of all prescriptions. According to researchers, targeting patients with moderate to low COPD would be the most effective method of reducing antibiotic use.

“Almost every patient with at least 1 acute exacerbation of COPD (AECOPD) was treated with an antibiotic during follow-up and even patients without a record of AECOPD received at least twice the number of antibiotics compared with the general population, highlighting the heavy use of antibiotics in patients with COPD,” said the study authors.

Study authors note that it remains difficult for general practitioners to distinguish between bacterial and non-bacterially medicated exacerbations, and the decision to prescribe antibiotics depends on the general practitioner’s experience and clinical judgment. However, study findings suggest that patients with mild to severe COPD are ideal for delayed antibiotic prescribing, making them an effective target for antibiotic reduction.

Reference

Rockenschaub P, Jhass A, Freemantle N, et al. 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). [published online October 9, 2019]. J Antimicrob Chemother. doi: 10.1093/jac/dkz411.