Adherence to guideline‐based antibiotic treatment for acute exacerbations of chronic obstructive pulmonary disease in an Australian tertiary hospital

Abstract

In a tertiary hospital, Australian guidelines for treating patients with an AECOPD were rarely followed. The use of guideline-discordant therapy resulted in longer hospital stays and incurred greater costs. Studies are required to determine the reasons behind such discordant practice and to develop initiatives to improve antibiotic prescribing.

Retrospective audit of antimicrobial prescribing practices for acute exacerbations of chronic obstructive pulmonary diseases in a large regional hospital

“…These results are similar to a recent Australian study in a metropolitan tertiary centre, which was able to demonstrate that guideline concordant therapy was associated with a reduced LOS; however in this study, there was a significantly lower rate of ceftriaxone prescribing than was seen at BHS. Australian guidelines recommend that patients with an AECOPD should only receive a single class of oral agent and do not recommend ceftriaxone in the treatment of AECOPD.…”

“…The timing of the sputum sample with regard to antibiotic administration was not able to be determined in this study due to a lack of documentation, and it is possible that the push to give antibiotics rapidly may have come at the expense of other investigations that may assist in de‐escalating treatment later during the episode of care. The percentage of isolated pathogens in this study was considerably lower than that seen by Fanning et al ., who reported 50 positive samples in a 84 patient cohort . There is also the potential that poorly collected samples with secretions from the upper respiratory tract were submitted for processing.…”

Antimicrobial prescription in patients dying from chronic obstructive pulmonary disease

“…Challenges in determining the aetiology and clinical course of a COPD exacerbation may go some way to explain the low rates of compliance with antimicrobial guidelines documented in previous studies . Fanning et al .…”

Variations in practice patterns and resource utilization in patients treated for chronic obstructive pulmonary disease

“…While COPD management guidelines are less definitive on route of antibiotic administration compared with steroid delivery, there is recognition that antibiotics are overused in relation to Global initiative for chronic Obstructive Lung Disease recommendations . Guideline‐discordant use of antibiotics (including inappropriate use of IV antibiotics) has also been shown to increase LOS and cost for patients admitted with AECOPD . Addressing the optimal route of antibiotic delivery therefore has the potential to reduce LOS and decrease the incidence of antibiotic‐related adverse events.…”