Antibiotic selection in the treatment of acute exacerbations of COPDKurt A. Wargo, Pharm.D., BCPS(AQ-ID), Ryan E. Owens, Pharm.D. Candidate 2014, Takova D. Wallace, Pharm.D. Candidate 2014

Auburn University Harrison School of Pharmacy & Huntsville Hospital

Objective Results Results ResultsThe goal of this study was to compare current practice trends in an 881-bed community hospital in North Alabama to established GOLD guideline recommendations for antibiotic selection in patients presenting during a COPD exacerbation. The main outcomes assessed were: 1) comparison of antibiotic selection to GOLD guideline recommendations; 2) determination of patients who are eligible to receive antibiotics based upon cardinal symptoms.

Methods

Conclusions

Disclosure

• Institutional Review Board approved•Retrospective, chart analysis conducted at an 881-bed regional referral hospital

Exclusion criteria:• Intensive care treatment•< 40 years of age•Concurrent respiratory disease

Procedure:•Medical history, specific pharmacotherapy for COPD prior to admission, in-hospital pharmacotherapy, and therapy upon hospital discharge were collected for analysis utilizing electronic medical records

•Cardinal symptoms of a COPD exacerbation were collected and analyzed with respect to appropriateness of antibiotic therapy

Table 1. Baseline Demographics

The authors have no financial or personal relationships with any commercial entities to disclose

Figure 3. Initial antibiotic selection

Figure 3: 2011 Alabama Statewide (Huntsville Hospital) Antibiogram

Figure 1. Percentage of patients meeting GOLD criteria for antibiotics   Male

N=99FemaleN=101

Age, yrs ± SD 68.2 ± 11.22 70.1 ± 9.96 

African-American (n) 16 

10

Caucasian (n) 

82 

91 

Hispanic (n) 1 

0

Home COPD Meds (n) None SABA SABA + SAAC Tiotropium Other combinations Theophylline Roflumilast Home O2

 157345227542

36

 197341218210

24

Concurrent Diseases (n) CHF MI Diabetes

 142333

 9

1521

Cardinal Symptoms Increased dyspnea Increased sputum volume Increased sputum purulence

954229

994822

Discussion

• This study demonstrates that even when antimicrobials are not indicated during COPD exacerbations, they are often times prescribed

• There is a need for improved antimicrobial stewardship & prescriber education regarding GOLD criteria to receive antibiotics

• An overwhelming majority of patients received antibiotic therapy who did not meet GOLD criteria

• GOLD guideline recommendations for antimicrobials in COPD exacerbations were not followed; however, local and regional susceptibility patterns do not correspond to the recommended antibiotics

• The majority of patients were given levofloxacin, which is appropriate based upon susceptibility patterns

23

4

73

3/3 Symptoms2/3 Symptoms with purulenceDid not meet criteria

Table 2: Number of patients who received antibiotics Antibiotic therapy given (N=186)

Met criteria, (n, %) 50 (27)

Did not meet criteria, (n, %) 136 (73)

0

20

40

60

80

100

120

140129

5143

25

5 4 3

Series1

Penicillin

Clindamycin

Azithromycin

Tetracycline

Trimethoprim-Sulfamethoxazole

Levofloxacin

Ceftriaxone

Cefepime

Meropenem

Piperacillin-tazobactam

Streptococcus pneumoniae

58(43) 75 44

(43) 71 63 98(100)

89(98) - - -

Haemophilus influenzae - - - (76) (100) (100) - - -

Pseudomonas aeruginosa - - - - - 78

(76) - 89(86)

91(91)

89(90)

Numbers in parentheses indicate percent susceptibility at Huntsville Hospital