title: An intervention with access to C-reactive protein rapid test reduces antibiotic overprescribing in acute exacerbations of chronic bronchitis and COPD.
abstract: BACKGROUND
  In acute exacerbation of chronic obstructive pulmonary disease (AECOPD) antibiotic overprescribing leads to antimicrobial resistance and underprescribing may cause poor patient outcomes.
  
  
  OBJECTIVE
  This study aimed to evaluate changes in over- and underprescribing of antibiotics after two interventions to optimize antibiotic prescribing in AECOPD in Spain.
  
  
  METHODS
  In 2008 and 2009, general practitioners (GPs) registered patients in a 3-week period before and after interventions. Two types of intervention were conducted: GPs in the full-intervention group (FIG) were exposed to a multifaceted intervention and given access to C-reactive protein (CRP) rapid test; partial-intervention group (PIG) was only exposed to the multifaceted intervention. Overprescribing was defined as antibiotic given to type III* exacerbation (≤ one Anthonisen Criteria); underprescribing was defined as no antibiotic given to type I exacerbation (three Anthonisen Criteria). A multivariate logistic regression model was used, considering antibiotic prescribing as the dependent variable.
  
  
  RESULTS
  A total of 210 GPs and 70 GPs were assigned to FIG and PIG, respectively, and 952 AECOPD patients were eligible for main analysis. After adjusting for clustering at GP level and for patient age and sex, we found that GPs in FIG significantly reduced antibiotic overprescribing; odds ratio (OR) = 0.35 (95% CI: 0.18-0.68, P = 0.003) and underprescribing was not significantly increased; OR = 0.25 (95% CI: 0.06 to 1.0, P = 0.075). No statistically significant changes were found in the PIG.
  
  
  CONCLUSIONS
  Antibiotic overprescribing was only reduced when CRP test was available. Simultaneously, underprescribing was not significantly increased, but this could be due to sample size limitations.
authors.affiliation: Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark and david.strykowski@hotmail.com.
authors.forename: David F
authors.initials: DF
authors.lastname: Strykowski
authors.affiliation: Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark and.
authors.forename: Anni B S
authors.initials: AB
authors.lastname: Nielsen
authors.affiliation: Primary Healthcare Centre Jaume I, University Rovira i Virgili, Tarragona, Spain.
authors.forename: Carl
authors.initials: C
authors.lastname: Llor
authors.affiliation: Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark and.
authors.forename: Volkert
authors.initials: V
authors.lastname: Siersma
authors.affiliation: Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark and.
authors.forename: Lars
authors.initials: L
authors.lastname: Bjerrum
mesh_terms: D000208:Acute Disease; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D029481:Bronchitis, Chronic / Q000188:drug therapy*; D002097:C-Reactive Protein / Q000032:analysis*; D018450:Disease Progression; D005260:Female; D058005:General Practitioners; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control*; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy*; D013030:Spain
chemical_list: D000900:Anti-Bacterial Agents; D002097:C-Reactive Protein
keywords: Antibacterial agents; C-reactive protein; chronic obstructive pulmonary disease; drug prescription; drug therapy; general practice; respiratory tract infections; therapeutic use.