{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T23:31:25Z","timestamp":1768347085661,"version":"3.49.0"},"reference-count":38,"publisher":"BMJ","issue":"1","funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health Research","doi-asserted-by":"publisher","award":["Dr Stolbrink is a NIHR Academic Clinical Fellow at"],"award-info":[{"award-number":["Dr Stolbrink is a NIHR Academic Clinical Fellow at"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000832","name":"Dowager Countess Eleanor Peel Trust","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000832","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open Resp Res"],"accepted":{"date-parts":[[2019,8,10]]},"published-print":{"date-parts":[[2019,9]]},"abstract":"<jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Antibiotics are routinely given to people with chronic obstructive pulmonary disease (COPD) presenting with lower respiratory tract infection (LRTI) symptoms in primary care. Population prescribing habits and their consequences have not been well-described.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We conducted a retrospective analysis of antibiotic prescriptions for non-pneumonic exacerbations of COPD from 2010 to 2015 using the UK primary care Optimum Patient Care Research Database. As a proxy of initial treatment failure, second antibiotic prescriptions for LRTI or all indications within 14 days were the primary and secondary outcomes, respectively. We derived a model for repeat courses using univariable and multivariable logistic regression analysis.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>A total of 8.4% of the 9042 incident events received further antibiotics for LRTI, 15.5% further courses for any indication. Amoxicillin and doxycycline were the most common index and second-line drugs, respectively (58.7% and 28.7%), mostly given for 7 days. Index drugs other than amoxicillin, cardiovascular disease, pneumococcal vaccination and more primary care consultations were statistically significantly associated with repeat prescriptions for LRTI (p&lt;0.05). The ORs and 95% CIs were: OR 1.28, 95% CI 1.10 to 1.49; OR 1.37, 95% CI 1.13 to 1.66; OR 1.33, 95% CI 1.14 to 1.55 and OR 1.05, 95% CI 1.02 to 1.07, respectively. Index duration, inhaled steroid use and exacerbation frequency were not statistically significant. The derived model had an area under the curve of 0.61, 95% CI 0.59 to 0.63.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>The prescription of multiple antibiotic courses for COPD exacerbations was relatively common\u2014one in twelve patients receiving antibiotics for LRTI had a further course within 2\u2009weeks. The findings support the current preference for amoxicillin as index drug within the limitations of this observational study. Further clinical trials to determine best practice in this common clinical situation appear required.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjresp-2019-000458","type":"journal-article","created":{"date-parts":[[2019,9,17]],"date-time":"2019-09-17T09:14:09Z","timestamp":1568711649000},"page":"e000458","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Antibiotics for COPD exacerbations: does drug or duration matter? A primary care database analysis"],"prefix":"10.1136","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6091-9316","authenticated-orcid":false,"given":"Marie","family":"Stolbrink","sequence":"first","affiliation":[{"name":"Institute of Infection and Global Health, University of Liverpool, Liverpool, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura J","family":"Bonnett","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, University of Liverpool, Liverpool, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John D","family":"Blakey","sequence":"additional","affiliation":[{"name":"Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia"},{"name":"Medical School, Curtin University, Perth, Western Australia, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2019,9,17]]},"reference":[{"key":"2025083110021460000_6.1.e000458.1","doi-asserted-by":"crossref","first-page":"2145","DOI":"10.1016\/S0140-6736(15)61340-X","article-title":"Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990\u20132013: quantifying the epidemiological transition","volume":"386","author":"Murray","year":"2015","journal-title":"The Lancet"},{"key":"2025083110021460000_6.1.e000458.2","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00130909"},{"key":"2025083110021460000_6.1.e000458.3","unstructured":"Institute for Health Metrics and Evaluation . Global burden of disease study, 2015. Available: http:\/\/ghdx.healthdata.org\/gbd-2015 [Accessed 21 Dec 2016]."},{"key":"2025083110021460000_6.1.e000458.4","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.0030442","article-title":"Projections of global mortality and burden of disease from 2002 to 2030","volume":"3","author":"Mathers","year":"2016","journal-title":"PLoS Med"},{"key":"2025083110021460000_6.1.e000458.5","unstructured":"World Health Organization . Chronic obstructive pulmonary disease (COPD). WHO, 2016."},{"key":"2025083110021460000_6.1.e000458.6","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(07)61382-8"},{"key":"2025083110021460000_6.1.e000458.7","doi-asserted-by":"crossref","unstructured":"Vollenweider DJ , Jarrett H , Steurer-Stey CA , et al . Antibiotics for exacerbations of chronic obstructive pulmonary disease. Cochrane database Syst Rev 2012;179.doi:10.1002\/14651858.CD010257","DOI":"10.1002\/14651858.CD010257"},{"key":"2025083110021460000_6.1.e000458.8","doi-asserted-by":"publisher","DOI":"10.1136\/thorax.57.9.759"},{"key":"2025083110021460000_6.1.e000458.9","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm.164.9.2105011"},{"key":"2025083110021460000_6.1.e000458.10","doi-asserted-by":"publisher","DOI":"10.1513\/pats.2306029"},{"key":"2025083110021460000_6.1.e000458.11","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-106-2-196"},{"key":"2025083110021460000_6.1.e000458.12","doi-asserted-by":"crossref","unstructured":"Wedzicha JA , Miravitlles M , Hurst JR , et al . Management of COPD exacerbations: a European Respiratory Society\/American Thoracic Society guideline. Eur Respir J 2017;49.doi:10.1183\/13993003.00791-2016","DOI":"10.1183\/13993003.00791-2016"},{"key":"2025083110021460000_6.1.e000458.13","unstructured":"Global Initiative for Chronic Obstructive Lung Disease . Pocket guide to COPD diagnosis, management and prevention - A Guide for Health Care Professionals, 2017. Available: http:\/\/goldcopd.org\/wp-content\/uploads\/2016\/12\/wms-GOLD-2017-Pocket-Guide.pdf [Accessed 23 Mar 2018]."},{"key":"2025083110021460000_6.1.e000458.14","unstructured":"World Health Organization . Global action plan on antimicrobial resistance, 2015. Available: http:\/\/www.who.int\/antimicrobial-resistance\/publications\/global-action-plan\/en\/ [Accessed 3 May 2015]."},{"key":"2025083110021460000_6.1.e000458.15","unstructured":"World Health Organization . Antimicrobial resistance: global report on surveillance, 2014. Available: http:\/\/www.who.int\/antimicrobial-resistance\/publications\/surveillancereport\/en\/ [Accessed 20 Dec 2016]."},{"key":"2025083110021460000_6.1.e000458.16","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dks202"},{"key":"2025083110021460000_6.1.e000458.17","unstructured":"Public Health England . English surveillance programme for antimicrobial utilisation and resistance (ESPAUR) - Executive summary and recommendations extracted from 2016 report, 2016. Available: https:\/\/www.gov.uk\/government\/publications\/english-surveillance-programme-antimicrobial-utilisation-and-resistance-espaur-report"},{"key":"2025083110021460000_6.1.e000458.18","doi-asserted-by":"publisher","DOI":"10.1177\/1753465812472387"},{"key":"2025083110021460000_6.1.e000458.19","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkx502"},{"key":"2025083110021460000_6.1.e000458.20","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0124374","article-title":"Antibiotic prescription for COPD exacerbations admitted to hospital: European COPD audit","volume":"10","author":"L\u00f3pez-Campos","year":"2015","journal-title":"PLoS One"},{"key":"2025083110021460000_6.1.e000458.21","unstructured":"National Institute for Health and Clinical Excellence (NICE) . Chronic obstructive pulmonary disease in over 16S: diagnosis and management. guidance and guidelines, 2010. Available: https:\/\/www.nice.org.uk\/guidance\/cg101\/chapter\/1-guidance#management-of-exacerbations-of-copd [Accessed 13 Jan 2017]."},{"key":"2025083110021460000_6.1.e000458.22","doi-asserted-by":"crossref","DOI":"10.1186\/s12890-017-0541-0","article-title":"Antibiotics for treatment of acute exacerbation of chronic obstructive pulmonary disease: a network meta-analysis","volume":"17","author":"Zhang","year":"2017","journal-title":"BMC Pulm Med"},{"key":"2025083110021460000_6.1.e000458.23","doi-asserted-by":"publisher","DOI":"10.1016\/j.rmed.2004.03.026"},{"key":"2025083110021460000_6.1.e000458.24","unstructured":"NIHR Statistics Group . NIHR statistics group annual meeting, 2017. Available: https:\/\/statistics-group.nihr.ac.uk\/nihr-statistics-group-annual-meeting-challenges-and-opportunities-for-applied-statisticians\/ [Accessed 8 Jan 2018]."},{"key":"2025083110021460000_6.1.e000458.25","doi-asserted-by":"publisher","DOI":"10.1136\/thoraxjnl-2014-205259"},{"key":"2025083110021460000_6.1.e000458.26","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkx504"},{"key":"2025083110021460000_6.1.e000458.27","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2466-13-32","article-title":"Variability of antibiotic prescribing in patients with chronic obstructive pulmonary disease exacerbations: a cohort study","volume":"13","author":"Boggon","year":"2013","journal-title":"BMC Pulm Med"},{"key":"2025083110021460000_6.1.e000458.28","doi-asserted-by":"publisher","DOI":"10.4104\/pcrj.2013.00061"},{"key":"2025083110021460000_6.1.e000458.29","doi-asserted-by":"crossref","first-page":"2601","DOI":"10.1093\/jac\/dky174","article-title":"Life-Long antimicrobial therapy: where is the evidence?","volume":"73","author":"JSY","year":"2018","journal-title":"J Antimicrob Chemother"},{"key":"2025083110021460000_6.1.e000458.30","unstructured":"National Institute for Health and Clinical Excellence (NICE) . Chronic obstructive pulmonary disease in over 16s: diagnosis and management, 2018. Available: https:\/\/www.nice.org.uk\/guidance\/ng115\/chapter\/Recommendations"},{"key":"2025083110021460000_6.1.e000458.31","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1177\/1479972317745734","article-title":"Does antibiotic treatment duration affect the outcomes of exacerbations of asthma and COPD? A systematic review","volume":"15","author":"Stolbrink","year":"2018","journal-title":"Chron Respir Dis"},{"key":"2025083110021460000_6.1.e000458.32","doi-asserted-by":"crossref","unstructured":"Pouwels KB , Hopkins S , Llewelyn MJ , et al . Duration of antibiotic treatment for common infections in English primary care: cross sectional analysis and comparison with guidelines. BMJ 2019;73.doi:10.1136\/bmj.l440","DOI":"10.1136\/bmj.l440"},{"key":"2025083110021460000_6.1.e000458.33","first-page":"548","article-title":"Antibiotic choice and duration associate with repeat prescriptions in infective asthma exacerbations","volume":"7","author":"Stolbrink","year":"2019","journal-title":"J Allergy Clin Immunol"},{"key":"2025083110021460000_6.1.e000458.34","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1408544"},{"key":"2025083110021460000_6.1.e000458.35","doi-asserted-by":"crossref","DOI":"10.1186\/s12931-017-0682-y","article-title":"A proposal for the withdrawal of inhaled corticosteroids in the clinical practice of chronic obstructive pulmonary disease","volume":"18","author":"Miravitlles","year":"2017","journal-title":"Respir Res"},{"key":"2025083110021460000_6.1.e000458.36","doi-asserted-by":"publisher","DOI":"10.1097\/MCP.0b013e328334c085"},{"key":"2025083110021460000_6.1.e000458.37","doi-asserted-by":"publisher","DOI":"10.1513\/AnnalsATS.201409-413OC"},{"key":"2025083110021460000_6.1.e000458.38","doi-asserted-by":"crossref","first-page":"642","DOI":"10.1513\/pats.200707-101TH","article-title":"Diagnosis of pathogens in exacerbations of chronic obstructive pulmonary disease","volume":"4","author":"Sykes","year":"2007","journal-title":"Proc Am Thorac Soc"}],"container-title":["BMJ Open Respiratory Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjresp-2019-000458","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,31]],"date-time":"2025-08-31T17:02:29Z","timestamp":1756659749000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopenrespres.bmj.com\/lookup\/doi\/10.1136\/bmjresp-2019-000458"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,9]]},"references-count":38,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2019,9,17]]},"published-print":{"date-parts":[[2019,9]]}},"alternative-id":["10.1136\/bmjresp-2019-000458"],"URL":"https:\/\/doi.org\/10.1136\/bmjresp-2019-000458","relation":{},"ISSN":["2052-4439"],"issn-type":[{"value":"2052-4439","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,9]]}}}