Antibiotic selection in the treatment of acute exacerbations of COPD Kurt 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 ObjectiveResultsResultsResults The 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=99 Female N=101 Age, yrs ± SD68.2 ± ± 9.96 African-American (n) Caucasian (n) Hispanic (n) 1 0 Home COPD Meds (n) None SABA SABA + SAAC Tiotropium Other combinations Theophylline Roflumilast Home O Concurrent Diseases (n) CHF MI Diabetes Cardinal Symptoms Increased dyspnea Increased sputum volume Increased sputum purulence 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 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) Penicillin Clindamycin Azithromycin Tetracycline Trimethoprim- Sulfamethoxazole Levofloxacin Ceftriaxone Cefepime Meropenem Piperacillin- tazobactam Streptococcus pneumoniae 58 (43) (43) (100) 89 (98) --- Haemophilus influenzae ---(76)(100) --- Pseudomonas aeruginosa (76) - 89 (86) 91 (91) 89 (90) Numbers in parentheses indicate percent susceptibility at Huntsville Hospital