Use of antibiotics in elderly patients with exacerbated COPD: the OLD-chronic obstructive pulmonary disease study.

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.