Use of Antibiotics in Elderly Patients with Exacerbated COPD: The OLD-Chronic Obstructive Pulmonary Disease Study

• Published in: Journal of the American Geriatrics Society (JAGS) 2006-04, Vol.54 (4), p.642-647
• Main Authors: Incalzi, Raffaele Antonelli, Corsonello, Andrea, Pedone, Claudio, Masotti, Giulio, Rengo, Franco, Grassi, Vittorio, Bellia, Vincenzo
• Format: Article
• Language: English
• Subjects: Aged; Anti-Bacterial Agents - therapeutic use; antibiotic; Antibiotics; Biological and medical sciences; Chronic obstructive pulmonary disease, asthma; Comorbidity; COPD exacerbation; elderly; Female; General aspects; Health Status; Hospitalization; Humans; Male; Medical sciences; Older people; Pneumology; Practice Patterns, Physicians' - statistics & numerical data; Pulmonary Disease, Chronic Obstructive - drug therapy; Respiratory diseases; Risk Factors; St. George Respiratory Questionnaire
• ISSN: 0002-8614; 1532-5415
• DOI: 10.1111/j.1532-5415.2006.00680.x

OBJECTIVES: To verify how frequently geriatric patients hospitalized for exacerbated chronic obstructive pulmonary disorder (COPD) had not been given antibiotics at home and to identify the relationship between the patient's condition and the prescribing practice. DESIGN: Observational study. SETTING: General medicine acute care wards. PARTICIPANTS: Four hundred fifty‐nine elderly patients admitted to the hospital because of exacerbated COPD. MEASUREMENTS: Indices of severity of COPD exacerbation, such as age, St. George Respiratory Questionnaire (SGRQ) score, number of exacerbations in the previous year, and Cumulative Illness Rating Scale score were considered in the analyses. RESULTS: Ninety (19.6%) patients had an antibiotic prescribed before admission. The prescription was not associated with older age and was weakly associated with greater comorbidity. Having more than four exacerbations (odds ratio (OR)=2.16, 95% confidence interval (CI)=1.27–3.66) and a SGRQ symptoms subscore greater than 70 (OR=1.61, 95% CI=1.0–2.68) were independent correlates of the use of antibiotics before admission, although 67% of patients reporting more than four exacerbations in the previous year and 73.1% of patients with a SGRQ symptoms subscore greater than 70 had not been given any antibiotic prescription at home. CONCLUSION: The majority of older patients hospitalized for exacerbated COPD had not been given antibiotics at home, although they had at least one index of exacerbation severity.