Antibiotic selection in the treatment of acute exacerbations of COPD Kurt A. Wargo, Pharm.D.,...
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Transcript of Antibiotic selection in the treatment of acute exacerbations of COPD Kurt A. Wargo, Pharm.D.,...
Antibiotic selection in the treatment of acute exacerbations of COPDKurt A. Wargo, Pharm.D., BCPS(AQ-ID), Ryan E. Owens, Pharm.D. Candidate 2014, Takova D. Wallace, Pharm.D. Candidate 2014
Auburn University Harrison School of Pharmacy & Huntsville Hospital
Objective Results Results ResultsThe goal of this study was to compare current practice trends in an 881-bed community hospital in North Alabama to established GOLD guideline recommendations for antibiotic selection in patients presenting during a COPD exacerbation. The main outcomes assessed were: 1) comparison of antibiotic selection to GOLD guideline recommendations; 2) determination of patients who are eligible to receive antibiotics based upon cardinal symptoms.
Methods
Conclusions
Disclosure
• Institutional Review Board approved•Retrospective, chart analysis conducted at an 881-bed regional referral hospital
Exclusion criteria:• Intensive care treatment•< 40 years of age•Concurrent respiratory disease
Procedure:•Medical history, specific pharmacotherapy for COPD prior to admission, in-hospital pharmacotherapy, and therapy upon hospital discharge were collected for analysis utilizing electronic medical records
•Cardinal symptoms of a COPD exacerbation were collected and analyzed with respect to appropriateness of antibiotic therapy
Table 1. Baseline Demographics
The authors have no financial or personal relationships with any commercial entities to disclose
Figure 3. Initial antibiotic selection
Figure 3: 2011 Alabama Statewide (Huntsville Hospital) Antibiogram
Figure 1. Percentage of patients meeting GOLD criteria for antibiotics Male
N=99FemaleN=101
Age, yrs ± SD 68.2 ± 11.22 70.1 ± 9.96
African-American (n) 16
10
Caucasian (n)
82
91
Hispanic (n) 1
0
Home COPD Meds (n) None SABA SABA + SAAC Tiotropium Other combinations Theophylline Roflumilast Home O2
157345227542
36
197341218210
24
Concurrent Diseases (n) CHF MI Diabetes
142333
9
1521
Cardinal Symptoms Increased dyspnea Increased sputum volume Increased sputum purulence
954229
994822
Discussion
• This study demonstrates that even when antimicrobials are not indicated during COPD exacerbations, they are often times prescribed
• There is a need for improved antimicrobial stewardship & prescriber education regarding GOLD criteria to receive antibiotics
• An overwhelming majority of patients received antibiotic therapy who did not meet GOLD criteria
• GOLD guideline recommendations for antimicrobials in COPD exacerbations were not followed; however, local and regional susceptibility patterns do not correspond to the recommended antibiotics
• The majority of patients were given levofloxacin, which is appropriate based upon susceptibility patterns
23
4
73
3/3 Symptoms2/3 Symptoms with purulenceDid not meet criteria
Table 2: Number of patients who received antibiotics Antibiotic therapy given (N=186)
Met criteria, (n, %) 50 (27)
Did not meet criteria, (n, %) 136 (73)
0
20
40
60
80
100
120
140129
5143
25
5 4 3
Series1
Penicillin
Clindamycin
Azithromycin
Tetracycline
Trimethoprim-Sulfamethoxazole
Levofloxacin
Ceftriaxone
Cefepime
Meropenem
Piperacillin-tazobactam
Streptococcus pneumoniae
58(43) 75 44
(43) 71 63 98(100)
89(98) - - -
Haemophilus influenzae - - - (76) (100) (100) - - -
Pseudomonas aeruginosa - - - - - 78
(76) - 89(86)
91(91)
89(90)
Numbers in parentheses indicate percent susceptibility at Huntsville Hospital