Emergency department antibiotic use for exacerbations of COPD

BACKGROUND: COPD is the third leading cause of death, with acute exacerbations accounting for 1.5 million emergency department (ED) visits annually. Guidelines include recommendations for antibiotic therapy, though evidence for benefit is limited, and little is known about ED prescribing patterns. Our objectives were to determine the rate with which ED patients with acute exacerbations of COPD (AECOPD) are treated with antibiotics, compare the proportions of antibiotic classes prescribed, describe trends of antibiotic treatment, and identify predictors of antibiotic therapy. PATIENTS AND METHODS: This was an analysis of the National Hospital Ambulatory Medical Care Survey (NHAMCS) for the years 2009–2014. Descriptive statistics were used to summarize the rate of antibiotic therapy and the relative proportions of each antibiotic class prescribed for AECOPD. Logistic regression was used to measure the trend in treatment rate over time and identify the variables associated with antibiotic use. RESULTS: There were an estimated 4.5 million ED visits for AECOPD. Antibiotic treatment occurred at a rate of 39%. Among those treated, macrolides (41%) and quinolones (35%) were prescribed most frequently. Logistic regression did not reveal a trend in antibiotic treatment over time and identified emergent/immediate triage level (OR 2.11, 95% CI 1.09–4.10) and elevated temperature (OR 7.92, 95% CI 2.28–27.50) as being independently associated with antibiotic therapy. CONCLUSION: Less than half of the ED visits for AECOPD resulted in antibiotic therapy, with no upward trend over time. Fever and triage level were predictive of antibiotic therapy, with macrolides and quinolones constituting the agents most commonly prescribed.