RT Journal Article SR Electronic 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 FD British Journal of General Practice SP e266 OP e272 DO 10.3399/BJGP.2020.0823 VO 71 IS 705 A1 David Gillespie A1 Christopher C Butler A1 Janine Bates A1 Kerenza Hood A1 Hasse Melbye A1 Rhiannon Phillips A1 Helen Stanton A1 Mohammed Fasihul Alam A1 Jochen WL Cals A1 Ann Cochrane A1 Nigel Kirby A1 Carl Llor A1 Rachel Lowe A1 Gurudutt Naik A1 Evgenia Riga A1 Bernadette Sewell A1 Emma Thomas-Jones A1 Patrick White A1 Nick A Francis YR 2021 UL http://bjgp.org/content/71/705/e266.abstract AB 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.