Background: In acute exacerbation of chronic obstructive pulmonary disease (AECOPD) antibiotic overprescribingleads toantimicrobialresistance andunderprescribing may cause poor patient outcomes.
Objective: This study aimed to evaluate changes in over- and underprescribingof antibiotics after two interventions to optimise antibiotic prescribing in AECOPD in Spain.
Methods:In 2008 and 2009 general practitioners (GPs) registered patients in 3-week periods before and after interventions. Two types of intervention were conducted: GPs in the full-intervention group (FIG) were exposed to a multifaceted intervention and given access to C-reactive protein (CRP) rapidtest; partial-intervention group (PIG) was only exposed to the multifaceted intervention. Overprescribing was defined as antibioticgiven to type III* exacerbation (≤ one Anthonisen Criteria); underprescribing was defined as no antibiotic given totype I exacerbation (three Anthonisen Criteria). A multivariate logistic regression model was used,considering antibiotic prescribing as the dependent variable.
Results:A total of 210 GPs and 70 GPs were assigned to FIG and PIG, respectively,and 952 AECOPD patients were eligible for main analysis. After adjusting for clustering at GP level and for patient age and sex, we found that GPs in FIG significantly reduced antibiotic overprescribing; Odds ratio (OR) =0.35 (95%CI: 0.18 to 0.68, P-value =0.003) and underprescribing was not significantly increased; OR =0.25 (95%CI: 0.06 to 1.0, P-value =0.075).No statistically significant changes were found in the PIG.
Conclusion:Antibiotic overprescribing wasonly reduced when CRP test was available.Simultaneously, underprescribing was not significantly increased, but this could be due to sample size limitations.