title: Is co-morbidity taken into account in the antibiotic management of elderly patients with acute bronchitis and COPD exacerbations?
abstract: BACKGROUND
  Guidelines on acute lower respiratory tract infections recommend restrictive use of antibiotics, however, in patients with relevant co-morbid conditions treatment with antibiotics should be considered. Presently, it is unknown whether GPs adhere to these guidelines and target antibiotic treatment more often at patients with risk-elevating conditions.
  
  
  OBJECTIVE
  We assessed whether in elderly primary care patients with acute bronchitis or exacerbations of chronic pulmonary disease (COPD), antibiotics are more often prescribed to patients with risk-elevating co-morbid conditions.
  
  
  METHODS
  Using the Utrecht GP research database, we analysed 2643 episodes in patients of 65 years of age or older with a GP-diagnosed acute bronchitis or exacerbation of COPD. Multivariable logistic regression analysis was applied to determine independent determinants of antibiotic use.
  
  
  RESULTS
  Antibiotic prescribing rates were high in both acute bronchitis (84%) and in exacerbations of COPD (53%). In acute bronchitis, only age was an independent determinant of antibiotic use [odds ratio (OR) 1.03, 95% confidence interval (CI) 1.003-1.048], whereas in exacerbations of COPD antibiotics were more often prescribed to male patients (OR 1.3, 95% CI 1.0-1.5), patients with diabetes (OR 1.7, 95% CI 1.1-2.4) and heart failure (OR 1.3, 95% CI 1.0-1.7).
  
  
  CONCLUSIONS
  Dutch GPs prescribe antibiotics in the majority of elderly patients with acute bronchitis and in half of the episodes of exacerbations of COPD. Tailoring their antibiotic treatment according to the presence or absence of high-risk co-morbid conditions could help GPs in improving antibiotic use in patients with respiratory tract infections in primary care.
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands. j.bont@umcutrecht.nl
authors.forename: Jettie
authors.initials: J
authors.lastname: Bont
authors.forename: Eelko
authors.initials: E
authors.lastname: Hak
authors.forename: Christine E
authors.initials: CE
authors.lastname: Birkhoff
authors.forename: Arno W
authors.initials: AW
authors.lastname: Hoes
authors.forename: Theo J M
authors.initials: TJ
authors.lastname: Verheij
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D001991:Bronchitis / Q000188:drug therapy* / Q000503:physiopathology; D015897:Comorbidity; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D009426:Netherlands; D017410:Practice Guidelines as Topic; D011320:Primary Health Care; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy*; D012141:Respiratory Tract Infections