An intervention with access to C-reactive protein rapid test reduces antibiotic overprescribing in acute exacerbations of chronic bronchitis and COPD.

In acute exacerbation of chronic obstructive pulmonary disease (AECOPD) antibiotic overprescribing leads to antimicrobial resistance and underprescribing may cause poor patient outcomes. This study aimed to evaluate changes in over- and underprescribing of antibiotics after two interventions to optimize antibiotic prescribing in AECOPD in Spain. In 2008 and 2009, general practitioners (GPs) registered patients in a 3-week period 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) rapid test; partial-intervention group (PIG) was only exposed to the multifaceted intervention. Overprescribing was defined as antibiotic given to type III* exacerbation (≤ one Anthonisen Criteria); underprescribing was defined as no antibiotic given to type I exacerbation (three Anthonisen Criteria). A multivariate logistic regression model was used, considering antibiotic prescribing as the dependent variable. 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: 0.18-0.68, P = 0.003) and underprescribing was not significantly increased; OR = 0.25 (95% CI: 0.06 to 1.0, P = 0.075). No statistically significant changes were found in the PIG. Antibiotic overprescribing was only reduced when CRP test was available. Simultaneously, underprescribing was not significantly increased, but this could be due to sample size limitations.

Strykowski DF ，Nielsen AB ，Llor C ，Siersma V ，Bjerrum L ... -  《-》

Inappropriate antibiotic prescription for respiratory tract indications: most prominent in adult patients.

Numerous studies suggest overprescribing of antibiotics for respiratory tract indications (RTIs), without really authenticating inappropriate prescription; the strict criteria of guideline recommendations were not taken into account as information on specific diagnoses, patient characteristics and disease severity was not available. The aim of this study is to quantify and qualify inappropriate antibiotic prescribing for RTIs. This is an observational study of the (antibiotic) management of patients with RTIs, using a detailed registration of RTI consultations by general practitioners (GPs). Consultations of which all necessary information was available were benchmarked to the prescribing guidelines for acute otitis media (AOM), acute sore throat, rhinosinusitis or acute cough. Levels of overprescribing for these indications and factors associated with overprescribing were determined. The overall antibiotic prescribing rate was 38%. Of these prescriptions, 46% were not indicated by the guidelines. Relative overprescribing was highest for throat (including tonsillitis) and lowest for ear consultations (including AOM). Absolute overprescribing was highest for lower RTIs (including bronchitis). Overprescribing was highest for patients between 18 and 65 years of age, when GPs felt patients' pressure for an antibiotic treatment, for patients presenting with fever and with complaints longer than 1 week. Underprescribing was observed in <4% of the consultations without a prescription. Awareness of indications and patient groups provoking antibiotic overprescribing can help in the development of targeted strategies to improve GPs' prescribing routines for RTIs.

Dekker AR ，Verheij TJ ，van der Velden AW 《-》

Predictors for antibiotic prescribing in patients with exacerbations of COPD in general practice.

Llor C ，Bjerrum L ，Munck A ，Hansen MP ，Córdoba GC ，Strandberg EL ，Ovhed I ，Radzeviciene R ，Cots JM ，Reutskiy A ，Caballero L ... -  《-》

C-reactive protein testing in patients with acute rhinosinusitis leads to a reduction in antibiotic use.

Llor C ，Bjerrum L ，Arranz J ，García G ，Cots JM ，González López-Valcárcel B ，Monedero MJ ，Gómez M ，Ortega J ，Guerra G ，Cid M ，Paredes J ，Pineda V ，Pérez C ，Alcántara Jde D ，Hernández S ... -  《-》

General practitioner use of a C-reactive protein point-of-care test to help target antibiotic prescribing in patients with acute exacerbations of chronic obstructive pulmonary disease (the PACE study): study protocol for a randomised controlled trial.

Bates J ，Francis NA ，White P ，Gillespie D ，Thomas-Jones E ，Breen R ，Kirby N ，Hood K ，Gal M ，Phillips R ，Naik G ，Cals J ，Llor C ，Melbye H ，Wootton M ，Riga E ，Cochrane A ，Howe R ，Fitzsimmons D ，Sewell B ，Alam MF ，Butler CC ... -  《Trials》