An observational study on factors influencing antibiotic use in chronic obstructive pulmonary disease at Universitas Academic Hospital, Bloemfontein

Background: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are often precipitated by excessive airway inflammation caused by viral or bacterial infections. Current guidelines suggest prescribing antibiotics to patients with AECOPD and purulent sputum production, but this may lead to unnecessary or inappropriate antibiotic use. The aim of this study was to identify clinical and laboratory variables influencing antibiotic prescriptions of clinicians managing patients hospitalised for AECOPD.Methods: An observational study was conducted among patients hospitalised with AECOPD. Antibiotic prescriptions were compared with sputum appearance, white blood cell count, C-reactive protein (CRP) levels and sputum cultures. Treatment outcomes were assessed on days 3 and 5 after admission.Results: Thirteen patients were included in the study, from July to October 2013, at Universitas Academic Hospital, Bloemfontein. Antibiotics were prescribed in seven out of eight patients with an elevated CRP level. None of the patients with reported sputum purulence received antibiotics. White blood cell count and sputum cultures did not seem to influence antibiotic prescription habits.Conclusions: Clinicians managing patients with AECOPD do not follow guidelines that suggest prescribing antibiotics to patients presenting with purulent sputum production. Further studies on whether biomarkers such as CRP may be more acceptable as a deciding factor on which to base antibiotic prescriptions are required