Determining factors in the prescription of moxifloxacin in exacerbations of chronic bronchitis in the primary-care setting.
OBJECTIVE
To describe the characteristics of patients and exacerbations that may determine the choice of an antibacterial in exacerbations of chronic bronchitis (ECB).


METHODS
This was a multicentre, observational study in ECB. A group of 225 primary-care practitioners were randomly selected to include 1007 patients. A logistic regression model was used to identify the characteristics of the physicians, patients and exacerbations associated with the choice of an antibacterial.


RESULTS
The mean age of the patients was 67.6 years (+/- SD 11) and 72.1% were male. In 91.4% of patients, the exacerbation was type I or II according to Anthonisen's classification. Most exacerbations (68.2%) were treated with moxifloxacin while only 31.8% were treated with other antibacterials. The more experienced practitioners (those with the longest professional careers and those who had higher numbers of patient-visits for chronic bronchitis) prescribed moxifloxacin more frequently (per each year of experience: OR 1.05; 95% CI 1.02, 1.07; per each additional patient-visit per week: OR 1.02; 95% CI 1.003, 1.04). The probability of receiving moxifloxacin increased with the severity of baseline dyspnoea (OR 1.94; 95% CI 1.27, 2.96) and decreased in smokers (OR 0.54; 95% CI 0.36, 0.81) and in patients receiving oral corticosteroids (OR 0.61; 95% CI 0.41, 0.90).


CONCLUSIONS
Prescription of moxifloxacin in primary care is significantly associated with more years of physician practice and with a higher severity of disease. The use of oral corticosteroids in exacerbations is commonly associated with other antibacterials (non-quinolones), either to improve antibacterial efficacy or because of doubtful bacterial aetiology, thus the preference for a narrow-spectrum antibacterial combined with an anti-inflammatory drug.
Miravitlles
Marc
M
Pneumology Department, Clinical Institute of Thorax (IDIBAPS), Clinic Hospital, Barcelona, Spain. marcm@clinic.ub.es
Llor
Carles
C
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001372:Aza Compounds / Q000627:therapeutic use*; D029481:Bronchitis, Chronic / Q000188:drug therapy* / Q000503:physiopathology; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D024841:Fluoroquinolones; D006801:Humans; D008297:Male; D008875:Middle Aged; D000077266:Moxifloxacin; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data*; D011804:Quinolines / Q000627:therapeutic use*; D012720:Severity of Illness Index
D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents; D001372:Aza Compounds; D024841:Fluoroquinolones; D011804:Quinolines; D000077266:Moxifloxacin