title: Use of long-term antibiotic treatment in COPD patients in the UK: a retrospective cohort study.
abstract: BACKGROUND
  Exacerbations of chronic obstructive pulmonary disease (COPD) are a burden to patients and impose a major cost on health services. Long-term antibiotic therapy may prevent exacerbations, but at present it is not recommended by management guidelines.
  
  
  OBJECTIVE
  To identify the type and prevalence of long-term oral antibiotic treatments prescribed to patients with COPD and to assess the patient characteristics associated with long-term antibiotic use.
  
  
  METHODS
  A retrospective cohort using all eligible practices in The Health Improvement Network (THIN) UK primary care database between 2000 and 2009 was studied. We identified patients with COPD and then those who received a course of long-term antibiotics. Long-term courses were defined as >6 months in duration with <50% concomitant oral corticosteroid treatment.
  
  
  RESULTS
  We identified 92,576 patients with COPD, but only 567 patients (0.61%) who received 998 long-term antibiotic courses. Mean follow-up time was 3 years and 10 months. The median long-term antibiotic course length was 280 days (interquartile range 224, 394) and 58 patients (0.06%) were continuously prescribed antibiotics for >2 years. The most commonly used long-term antibiotics were oxytetracycline, doxycycline, and penicillin. Azithromycin, erythromycin, and clarithromycin were less frequently used. There was little evidence of the use of rotating courses of antibiotics. Men, people aged 50-79 years, non-smokers, and patients with poorer lung function were more likely to receive long-term antibiotic treatment.
  
  
  CONCLUSIONS
  Relatively few COPD patients are currently prescribed long-term antibiotics. Further clinical trials are required to determine the efficacy of this therapy. If beneficial, the use of such treatments should be incorporated into clinical guidelines.
authors.affiliation: Department of Primary Care and Population Health, UCL Medical School, Royal Free Campus, London, UK • Centre for Respiratory Medicine, University College London, Royal Free Campus, London, UK.
authors.forename: Gareth Dean Russell
authors.initials: GD
authors.lastname: James
authors.forename: Irene
authors.initials: I
authors.lastname: Petersen
authors.forename: Irwin
authors.initials: I
authors.lastname: Nazareth
authors.forename: Jadwiga A
authors.initials: JA
authors.lastname: Wedzicha
authors.forename: Gavin C
authors.initials: GC
authors.lastname: Donaldson
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017963:Azithromycin / Q000627:therapeutic use; D017291:Clarithromycin / Q000627:therapeutic use; D015331:Cohort Studies; D018450:Disease Progression; D004318:Doxycycline / Q000627:therapeutic use; D004917:Erythromycin / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010118:Oxytetracycline / Q000627:therapeutic use; D010406:Penicillins / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D029424:Pulmonary Disease, Chronic Obstructive / Q000517:prevention & control*; D012189:Retrospective Studies; D012737:Sex Factors; D006113:United Kingdom
chemical_list: D000900:Anti-Bacterial Agents; D010406:Penicillins; D004917:Erythromycin; D017963:Azithromycin; D017291:Clarithromycin; D004318:Doxycycline; D010118:Oxytetracycline