Abstract
Limited information is available about current practice patterns involving the use of antibiotics in the inpatient management of acute exacerbations of chronic obstructive pulmonary disease (AECOPD). We sought to characterize current patterns of antibiotic use and to compare them to evidence-based guidelines. This study is a retrospective case series of patients at a regional tertiary care medical center. Charts were reviewed to identify patients admitted between January 2006 and 2008 with an initial diagnosis of AECOPD who had no evidence of another infectious process and who were not immunocompromised. Relevant data extracted from charts included initial clinical presentation, antibiotic administration, microbiological studies, and hospital course. One hundred sixteen admissions meeting inclusion criteria were identified. There was no statistically significant relationship between the presence of an established indication for antibiotic administration and the use of antibiotics, with roughly 75% of patients in all groups receiving therapy. A significant fraction of patients received combination therapy that was more appropriate for the management of pneumonia than for AECOPD. There were significant deviations between practice patterns and guidelines regarding the use and selection of antibiotics. Some of these may reflect areas of uncertainty in the primary literature and varying sets of guidelines.
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Mularski RA, Asch SM, Shrank WH, Kerr EA, Setodji CM, Adams JL, Keesey J, McGlynn EA (2006) The quality of obstructive lung disease care for adults in the United States as measured by adherence to recommended processes. Chest 130:1844–1850. doi:10.1378/chest.130.6.1844
Rudolf M (2000) The reality of drug use in COPD: the European Perspective. Chest 117:29S–32S. doi:10.1378/chest.117.2_suppl.29S
Roche N, Lepage T, Bourcereau J, Terrioux P (2001) Guidelines versus clinical practice in the treatment of chronic obstructive pulmonary disease. Eur Respir J 18:903–908. doi:10.1183/09031936.01.00213701
Miravitlles M, Mayordomo C, Artes M, Sánchez-Agudo L, Nicolau F, Segú JL (1999) Treatment of chronic obstructive pulmonary disease and its exacerbations in general practice. Respir Med 93:173–179
Chang CL, Sullivan GD, Karalus NC, Hancox RJ, McLachlan JD, Mills GD (2007) Audit of acute admissions of chronic obstructive pulmonary disease: inpatient management and outcome. Intern Med J 37:236–241. doi:10.1111/j.1445-5994.2006.01283.x
Roberts CM, Ryland I, Lowe D, Kelly Y, Bucknall CE, Pearson MG, Audit Sub-committee of the Standards of Care Committee, British Thoracic Society; Clinical Effectiveness, Evaluation Unit, Royal College of Physicians (2001) Audit of acute admissions of COPD: standards of care and management in the hospital setting. Eur Respir J 17:343–349
Butler MW, O’Mahony MJ, Donnelly SC, McDonnell TJ (2004) Managing exacerbations for COPD: room for improvement. Ir Med J 97:108–110
Lindenauer PK, Pekow P, Gao S, Crawford AS, Gutierrez B, Benjamin EM (2006) Quality of care for patients hospitalized for acute exacerbations of chronic obstructive pulmonary disease. Ann Intern Med 144:894–903
Simoens S, Decramer M, De Coster S, Celis G, Laekeman G (2007) Clinical and economic analysis of antimicrobial therapy of chronic obstructive pulmonary disease exacerbations. Int J Clin Pract 61:200–206. doi:10.1111/j.1742-1241.2006.01240.x
Practice Guidelines of the Global Initiative for Chronic Obstructive Lung Disease. http://www.goldcopd.com/Guidelineitem.asp?l1=2&l2=1&intId=996. Accessed January 28, 2009
Ram FS, Rodriguez-Roisin R, Granados-Navarrete A, Garcia-Aymerich J, Barnes NC (2006) Antibiotics for exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2:CD004403. doi:10.1002/14651858.CD004403.pub2
Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, Dowell SF, File TM Jr, Musher DM, Niederman MS, Torres A, Whitney CG, Infectious Diseases Society of America; American Thoracic Society (2007) Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 44:S27–S72. doi:10.1086/511159
Cabana MD, Rand CS, Powe NR, Wu AW, Wilson MH, Abboud PA, Rubin HR (1999) Why don’t physicians follow clinical practice guidelines? A framework for improvement. JAMA 282:1458–1465
Anthonisen NR, Manfreda J, Warren CP, Hershfield ES, Harding GK, Nelson NA (1987) Antibiotic therapy in exacerbations of chronic obstructive pulmonary disease. Ann Intern Med 106:196–204
Quon BS, Gan WQ, Sin DD (2008) Contemporary management of acute exacerbations of COPD: a systematic review and meta-analysis. Chest 133:756–766. doi:10.1378/chest.07-1207
Bartlett JG, Sethi S (2008) Diagnosis and treatment of infection in acute exacerbations of chronic obstructive pulmonary disease. http://www.UpToDate.com. Accessed on December 20, 2008
Nouira S, Marghli S, Belghith M, Besbes L, Elatrous S, Abroug F (2001) Once daily oral ofloxacin in chronic obstructive pulmonary disease exacerbation requiring mechanical ventilation: a randomized placebo-controlled trial. Lancet 358:2020–2025. doi:10.1016/S0140-6736(01)07097-0
Celli BR, MacNee W, ATS/ERS Task Force (2004) Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper. Eur Respir J 23:932–946. doi:10.1183/09031936.04.00014304
Snow V, Lascher S, Mottur-Pilson C, Joint Expert Panel on Chronic Obstructive ulmonary Disease of the American College of Chest Physicians, the American College of Physicians-American Society of Internal Medicine (2001) Evidence base for the management of acute exacerbations of chronic obstructive pulmonary disease. Ann Intern Med 134:595–599
National Collaborating Centre for Chronic Conditions (2004) National clinical guideline on the management of chronic obstructive pulmonary disease in adults in primary and secondary care. Thorax 59(1):1–232 (PMID 15041752)
Basi SK, Marrie TJ, Huang JQ, Majumdar SR (2004) Patients admitted to hospital with suspected pneumonia and normal chest radiographs: epidemiology, microbiology, and outcomes. Am J Med 117:305–331. doi:10.1016/j.amjmed.2004.03.029
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Farkas, J.D., Manning, H.L. Guidelines Versus Clinical Practice in Antimicrobial Therapy for COPD. Lung 188, 173–178 (2010). https://doi.org/10.1007/s00408-009-9216-9
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DOI: https://doi.org/10.1007/s00408-009-9216-9