ArticleBMC pulmonary medicine2013
Variability of antibiotic prescribing in patients with chronic obstructive pulmonary disease exacerbations: a cohort study.
Article in BMC pulmonary medicine, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers, 1 of them a synthesis that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
17 citing papers in PubMed, 1 synthesis or guideline pooled it, 31 citations in OpenAlex.
- Chronic Obstructive Pulmonary Disease and the Management of Cardiopulmonary Risk in the UK: A Systematic Literature Review and Modified Delphi Study.International journal of chronic obstructive pulmonary disease · 2025Pooled it
- Patients' perspectives on antimicrobial resistance in chronic respiratory disease: an AMR-Lung/European Lung Foundation global patient survey.ERJ open research · 2025Article
- Comparing antibiotic prescribing between clinicians in UK primary care: an analysis in a cohort study of eight different measures of antibiotic prescribing.BMJ quality & safety · 2022Article
- Real-World Effects of Antibiotic Treatment on Acute COPD Exacerbations in Outpatients: A Cohort Study under the PharmLines Initiative.Respiration; international review of thoracic diseases · 2022Article
- Article
- Opportunities to reduce antibiotic prescribing for patients with COPD in primary care: a cohort study using electronic health records from the Clinical Practice Research Datalink (CPRD).The Journal of antimicrobial chemotherapy · 2020Observational
- Antibiotics for COPD exacerbations: does drug or duration matter? A primary care database analysis.BMJ open respiratory research · 2019Article
- Actual versus 'ideal' antibiotic prescribing for common conditions in English primary care.The Journal of antimicrobial chemotherapy · 2018Article
- Antibiotic prescriptions to adults with acute respiratory tract infections by Italian general practitioners.Infection and drug resistance · 2018Article
- Opportunities for primary care to reduce hospital admissions: a cross-sectional study of geographical variation.The British journal of general practice : the journal of the Royal College of General Practitioners · 2017Article
- The economic burden of asthma and chronic obstructive pulmonary disease and the impact of poor inhalation technique with commonly prescribed dry powder inhalers in three European countries.BMC health services research · 2016Article
- Article
- Antibiotic use varies substantially among adults: a cross-national study from five European Countries in the ARITMO project.Infection · 2015Article
- Quantifying the risk of multiple myeloma from symptoms reported in primary care patients: a large case-control study using electronic records.The British journal of general practice : the journal of the Royal College of General Practitioners · 2015Article
- Continued high rates of antibiotic prescribing to adults with respiratory tract infection: survey of 568 UK general practices.BMJ open · 2014Article
- Study of drug utilization pattern for acute exacerbation of chronic obstructive pulmonary disease in patients attending a government hospital in kerala, India.Journal of family medicine and primary care · 2014Article
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Corrections and comments
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Authors and funding
8 authors at 7 institutions in 2 countries.
Funding
Abstract
backgroundThe role of antibiotics in treating mild or moderate exacerbations in patients with acute chronic obstructive pulmonary disease (COPD) is unclear. The aims were to: (i) describe patient characteristics associated with acute exacerbations amongst a representative COPD population, (ii) explore the relationship between COPD severity and outcomes amongst patients with exacerbations, and (iii) quantify variability by general practice in prescribing of antibiotics for COPD exacerbations.
methodA cohort of 62,747 patients with COPD was identified from primary care general practices (GP) in England, and linked to hospital admission and death certificate data. Exacerbation cases were matched to three controls and characteristics compared using conditional logistic regression. Outcomes were compared using incidence rates and Cox regression, stratified by disease severity. Variability of prescribing at the GP level was evaluated graphically and by using multilevel models.
resultsCOPD severity was found to be associated with exacerbation and subsequent mortality (very severe vs. mild, odds ratio for exacerbation 2.12 [95%CI 19.5-2.32]), hazard ratio for mortality 2.14 [95%CI 1.59-2.88]). Whilst 61% of exacerbation cases were prescribed antibiotics, this proportion varied considerably between GP practices (interquartile range, 48-73%). This variation is greater than can be explained by patient characteristics alone.
conclusionsThere is significant variability between GP practices in the prescribing of antibiotics to COPD patients experiencing exacerbations. Combined with a lack of evidence on the effects of treatment, this supports the need and opportunity for a large scale pragmatic randomised trial of the prescribing of antibiotics for COPD patients with exacerbations, in order to clarify their effectiveness and long term outcomes whilst ensuring the representativeness of subjects.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.