TY - JOUR T1 - Associations with antibiotic prescribing for acute exacerbation of COPD in primary care: secondary analysis of a randomised controlled trial JF - British Journal of General Practice JO - Br J Gen Pract SP - e266 LP - e272 DO - 10.3399/BJGP.2020.0823 VL - 71 IS - 705 AU - David Gillespie AU - Christopher C Butler AU - Janine Bates AU - Kerenza Hood AU - Hasse Melbye AU - Rhiannon Phillips AU - Helen Stanton AU - Mohammed Fasihul Alam AU - Jochen WL Cals AU - Ann Cochrane AU - Nigel Kirby AU - Carl Llor AU - Rachel Lowe AU - Gurudutt Naik AU - Evgenia Riga AU - Bernadette Sewell AU - Emma Thomas-Jones AU - Patrick White AU - Nick A Francis Y1 - 2021/04/01 UR - http://bjgp.org/content/71/705/e266.abstract N2 - Background C-reactive protein (CRP) point-of-care testing can reduce antibiotic use in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in primary care, without compromising patient care. Further safe reductions may be possible.Aim To investigate the associations between presenting features and antibiotic prescribing in patients with AECOPD in primary care.Design and setting Secondary analysis of a randomised controlled trial of participants presenting with AECOPD in primary care (the PACE trial).Method Clinicians collected participants’ demographic features, comorbid illnesses, clinical signs, and symptoms. Antibiotic prescribing decisions were made after participants were randomised to receive a point-of-care CRP measurement or usual care. Multivariable regression models were fitted to explore the association between patient and clinical features and antibiotic prescribing, and extended to further explore any interactions with CRP measurement category (CRP not measured, CRP <20 mg/l, or CRP ≥20 mg/l).Results A total of 649 participants from 86 general practices across England and Wales were included. Odds of antibiotic prescribing were higher in the presence of clinician-recorded crackles (adjusted odds ratio [AOR] = 5.22, 95% confidence interval [CI] = 3.24 to 8.41), wheeze (AOR = 1.64, 95% CI = 1.07 to 2.52), diminished vesicular breathing (AOR = 2.95, 95% CI = 1.70 to 5.10), or clinician-reported evidence of consolidation (AOR = 34.40, 95% CI = 2.84 to 417.27). Increased age was associated with lower odds of antibiotic prescribing (AOR per additional year increase = 0.98, 95% CI = 0.95 to 1.00), as was the presence of heart failure (AOR = 0.32, 95% CI = 0.12 to 0.85).Conclusion Several demographic features and clinical signs and symptoms are associated with antibiotic prescribing in AECOPD. Diagnostic and prognostic value of these features may help identify further safe reductions. ER -