Antibiotics used in the ambulatory management of acute COPD exacerbations

Marie-France Beauchesne1,2,3, Marcel Julien2,4, Louis-André Julien2,4, Dominique Piquette4, Amélie Forget2, Manon Labrecque2,4, Lucie Blais1,2,31Faculty of Pharmacy, 4Faculty of Medicine, University of Montréal, Montréal, Québec, Canada; 2Hôpital du Sacré-Coeur de Montréal, Gouin Ouest, Montréal, Québec, Canada; 3Endowment Pharmaceutical Chair AstraZeneca in Respiratory Health, Montréal, Québec, CanadaStudy objectives: This study was conducted to describe the different antibiotics that are used in the home management of chronic obstructive pulmonary disease (COPD) exacerbations and to estimate the failure rates following the initiation of the antibiotic.Methods: A cohort study was conducted. Patients enrolled in a COPD home management program were included in the analysis. Failure rates were defined as an additional prescription of an antibiotic, an emergency room visit, or a hospitalization for a COPD exacerbation in the 30 days following the initiation of the antibiotic.Results: A total of 1180 episodes of antibiotic treatment were analyzed. Overall, 348 episodes led to a failure (29.5%). The most frequently used antibiotics were cefuroxime (45.9%) and ciprofloxacin (21.1%).Conclusion: This project demonstrates that a wide range of antibiotics were prescribed to our population of COPD patients with a moderate to severe form of the disease. Many treatment failures (about 30%) occurred in the 30-day period following the initiation of the home therapy with an antibiotic. Clinicians should be aware of this high failure rate when managing mild exacerbations of COPD at home.Keywords: acute exacerbation of COPD, antibiotics, COP