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Is co-morbidity taken into account in the antibiotic management of elderly patients with acute bronchitis and COPD exacerbations?
Fam Pract 2007; 24(4):317-22FP

Abstract

BACKGROUND

Guidelines on acute lower respiratory tract infections recommend restrictive use of antibiotics, however, in patients with relevant co-morbid conditions treatment with antibiotics should be considered. Presently, it is unknown whether GPs adhere to these guidelines and target antibiotic treatment more often at patients with risk-elevating conditions.

OBJECTIVES

We assessed whether in elderly primary care patients with acute bronchitis or exacerbations of chronic pulmonary disease (COPD), antibiotics are more often prescribed to patients with risk-elevating co-morbid conditions.

METHODS

Using the Utrecht GP research database, we analysed 2643 episodes in patients of 65 years of age or older with a GP-diagnosed acute bronchitis or exacerbation of COPD. Multivariable logistic regression analysis was applied to determine independent determinants of antibiotic use.

RESULTS

Antibiotic prescribing rates were high in both acute bronchitis (84%) and in exacerbations of COPD (53%). In acute bronchitis, only age was an independent determinant of antibiotic use [odds ratio (OR) 1.03, 95% confidence interval (CI) 1.003-1.048], whereas in exacerbations of COPD antibiotics were more often prescribed to male patients (OR 1.3, 95% CI 1.0-1.5), patients with diabetes (OR 1.7, 95% CI 1.1-2.4) and heart failure (OR 1.3, 95% CI 1.0-1.7).

CONCLUSION

Dutch GPs prescribe antibiotics in the majority of elderly patients with acute bronchitis and in half of the episodes of exacerbations of COPD. Tailoring their antibiotic treatment according to the presence or absence of high-risk co-morbid conditions could help GPs in improving antibiotic use in patients with respiratory tract infections in primary care.

Authors+Show Affiliations

Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands. j.bont@umcutrecht.nlNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17602175

Citation

Bont, Jettie, et al. "Is Co-morbidity Taken Into Account in the Antibiotic Management of Elderly Patients With Acute Bronchitis and COPD Exacerbations?" Family Practice, vol. 24, no. 4, 2007, pp. 317-22.
Bont J, Hak E, Birkhoff CE, et al. Is co-morbidity taken into account in the antibiotic management of elderly patients with acute bronchitis and COPD exacerbations? Fam Pract. 2007;24(4):317-22.
Bont, J., Hak, E., Birkhoff, C. E., Hoes, A. W., & Verheij, T. J. (2007). Is co-morbidity taken into account in the antibiotic management of elderly patients with acute bronchitis and COPD exacerbations? Family Practice, 24(4), pp. 317-22.
Bont J, et al. Is Co-morbidity Taken Into Account in the Antibiotic Management of Elderly Patients With Acute Bronchitis and COPD Exacerbations. Fam Pract. 2007;24(4):317-22. PubMed PMID: 17602175.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Is co-morbidity taken into account in the antibiotic management of elderly patients with acute bronchitis and COPD exacerbations? AU - Bont,Jettie, AU - Hak,Eelko, AU - Birkhoff,Christine E, AU - Hoes,Arno W, AU - Verheij,Theo J M, Y1 - 2007/06/29/ PY - 2007/7/3/pubmed PY - 2008/1/25/medline PY - 2007/7/3/entrez SP - 317 EP - 22 JF - Family practice JO - Fam Pract VL - 24 IS - 4 N2 - BACKGROUND: Guidelines on acute lower respiratory tract infections recommend restrictive use of antibiotics, however, in patients with relevant co-morbid conditions treatment with antibiotics should be considered. Presently, it is unknown whether GPs adhere to these guidelines and target antibiotic treatment more often at patients with risk-elevating conditions. OBJECTIVES: We assessed whether in elderly primary care patients with acute bronchitis or exacerbations of chronic pulmonary disease (COPD), antibiotics are more often prescribed to patients with risk-elevating co-morbid conditions. METHODS: Using the Utrecht GP research database, we analysed 2643 episodes in patients of 65 years of age or older with a GP-diagnosed acute bronchitis or exacerbation of COPD. Multivariable logistic regression analysis was applied to determine independent determinants of antibiotic use. RESULTS: Antibiotic prescribing rates were high in both acute bronchitis (84%) and in exacerbations of COPD (53%). In acute bronchitis, only age was an independent determinant of antibiotic use [odds ratio (OR) 1.03, 95% confidence interval (CI) 1.003-1.048], whereas in exacerbations of COPD antibiotics were more often prescribed to male patients (OR 1.3, 95% CI 1.0-1.5), patients with diabetes (OR 1.7, 95% CI 1.1-2.4) and heart failure (OR 1.3, 95% CI 1.0-1.7). CONCLUSION: Dutch GPs prescribe antibiotics in the majority of elderly patients with acute bronchitis and in half of the episodes of exacerbations of COPD. Tailoring their antibiotic treatment according to the presence or absence of high-risk co-morbid conditions could help GPs in improving antibiotic use in patients with respiratory tract infections in primary care. SN - 0263-2136 UR - https://www.unboundmedicine.com/medline/citation/17602175/Is_co_morbidity_taken_into_account_in_the_antibiotic_management_of_elderly_patients_with_acute_bronchitis_and_COPD_exacerbations L2 - https://academic.oup.com/fampra/article-lookup/doi/10.1093/fampra/cmm023 DB - PRIME DP - Unbound Medicine ER -