Evidence map›Paper›PMID 33657007›Full record

Trial reportThe British journal of general practice : the journal of the Royal College of General Practitioners2021

Associations with antibiotic prescribing for acute exacerbation of COPD in primary care: secondary analysis of a randomised controlled trial.

David Gillespie, Christopher C Butler, Janine Bates, Kerenza Hood, Hasse Melbye, Rhiannon Phillips, Helen Stanton, Mohammed Fasihul Alam, Jochen Wl Cals, Ann Cochrane and 9 more

Open access · hybridAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in The British journal of general practice : the journal of the Royal College of General Practitioners, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed, 1 pooled it
2.2field-weighted citation impact, top 13% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 1 synthesis or guideline pooled it, 9 citations in OpenAlex.

  1. Pooled it
  2. Trial
  3. Article
  4. Observational
  5. Article
  6. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

19 authors at 9 institutions in 4 countries.

David GillespieNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK; Centre for Trials Research, School of Medicine, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK.
Christopher C ButlerNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Janine BatesCentre for Trials Research, School of Medicine, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK.
Kerenza HoodCentre for Trials Research, School of Medicine, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK.
Hasse MelbyeGeneral Practice Research Unit, Department of Community Medicine, UIT the Arctic University of Norway, Tromsø, Norway.
Rhiannon PhillipsCardiff School of Sport and Health Science, Cardiff Metropolitan University, Cardiff, UK.
Helen StantonCentre for Trials Research, School of Medicine, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK.
Mohammed Fasihul AlamDepartment of Public Health, College of Health Sciences, QU-Health, Qatar University, Doha, Qatar.
Jochen Wl CalsDepartment of Family Medicine, School for Public Health and Primary Care, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.
Ann CochraneYork Trials Unit, Department of Health Sciences, University of York, York, UK.
Nigel KirbyCentre for Trials Research, School of Medicine, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK.
Carl LlorResearch Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; University Institute in Primary Care Research Jordi Gol, Via Roma Health Centre, Barcelona, Spain.
Rachel LoweCentre for Trials Research, School of Medicine, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK.
Gurudutt NaikDivision of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK.
Evgenia RigaDepartment of Psychiatry, Medical Sciences Division, University of Oxford, Oxford, UK.
Bernadette SewellSwansea Centre for Health Economics, Swansea University, Swansea, UK.
Emma Thomas-JonesCentre for Trials Research, School of Medicine, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK.
Patrick WhiteSchool of Population Health and Environmental Sciences, King's College London, London, UK.
Nick A FrancisPrimary Care, Population Sciences and Medical Education, University of Southampton, Aldermoor Health Centre, Southampton, UK.
University of Oxford · GBCardiff University · GBKing's College London · GBQatar University · QASwansea University · GBUiT The Arctic University of Norway · NOUniversity of Copenhagen · DKUniversity of Southampton · GBUniversity of York · GB

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundC-reactive protein (CRP) point-of-care testing can reduce antibiotic use in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in primary care, without compromising patient care. Further safe reductions may be possible.

aimTo investigate the associations between presenting features and antibiotic prescribing in patients with AECOPD in primary care. DESIGN AND

settingSecondary analysis of a randomised controlled trial of participants presenting with AECOPD in primary care (the PACE trial).

methodClinicians collected participants' demographic features, comorbid illnesses, clinical signs, and symptoms. Antibiotic prescribing decisions were made after participants were randomised to receive a point-of-care CRP measurement or usual care. Multivariable regression models were fitted to explore the association between patient and clinical features and antibiotic prescribing, and extended to further explore any interactions with CRP measurement category (CRP not measured, CRP <20 mg/l, or CRP ≥20 mg/l).

resultsA total of 649 participants from 86 general practices across England and Wales were included. Odds of antibiotic prescribing were higher in the presence of clinician-recorded crackles (adjusted odds ratio [AOR] = 5.22, 95% confidence interval [CI] = 3.24 to 8.41), wheeze (AOR = 1.64, 95% CI = 1.07 to 2.52), diminished vesicular breathing (AOR = 2.95, 95% CI = 1.70 to 5.10), or clinician-reported evidence of consolidation (AOR = 34.40, 95% CI = 2.84 to 417.27). Increased age was associated with lower odds of antibiotic prescribing (AOR per additional year increase = 0.98, 95% CI = 0.95 to 1.00), as was the presence of heart failure (AOR = 0.32, 95% CI = 0.12 to 0.85).

conclusionSeveral demographic features and clinical signs and symptoms are associated with antibiotic prescribing in AECOPD. Diagnostic and prognostic value of these features may help identify further safe reductions.

Indexed as

Pulmonary Disease, Chronic ObstructiveRespiratory Tract InfectionsAnti-Bacterial AgentsEnglandHumansPrimary Health CareWalesAnti-Bacterial AgentsantibioticsCOPDC-reactive proteinprimary carerandomised controlled trial

Identifiers

PMID33657007
PMCPMC8007268
OpenAlexW3134474625

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

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.