Clinical practice differs from guidelines in antibiotic therapy for COPD
MedWire News: There are significant deviations between practice patterns and guidelines regarding the use of antibiotics in patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD), research shows.
“According to the 2005–2007 annual guidelines by the Global Initiative for Chronic Obstructive Lung Disease (GOLD), antibiotics may be indicated on the basis of either the clinical history (increased sputum purulence accompanied by increased sputum volume and/or increased dyspnea) or the need for mechanical ventilation,” explain Joshua Farkas and Harold Manning from Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire, USA.
But they add: “There is limited information about clinicians’ adherence to guidelines for antibiotic use during inpatient management of AECOPD.”
To investigate, the team reviewed the medical charts of 116 patients, aged 42 to 91 years, who were admitted to a regional tertiary care medical center between 2006 and 2008 with an initial diagnosis of AECOPD. None of the patients were immunocompromised or had evidence of active nonpulmonary infections.
Overall, 75% of patients received antibiotics. However, there was no statistically significant relationship between the presence of an established indication for antibiotic administration (ie, increased sputum purulence) and the use of antibiotics among 98 of 105 patients who did not require ventilator support.
The researchers also note that 35% of patients received combination antibiotic therapy that was more appropriate for the management of pneumonia than for AECOPD, even though none of the patients had evidence of the former condition.
Farkas and Manning conclude in the journal Lung: “We found significant deviations between treatment guidelines and the actual use of antibiotics for patients admitted with AECOPD.”
They add: “Clinicians may deviate from guidelines for a variety of reasons, including lack of awareness, lack of agreement, and the presence of conflicting guidelines.”
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By Mark Cowen