EVALUATION OF AN ANTIBIOTIC PRESCRIBING PROTOCOL FOR TREATMENT OF ACUTE EXACERBATIONS OF CHRONIC OBSTRUCTIVE AIRWAYS DISEASE IN A HOSPITAL RESPIRATORY UNIT

A prescribing protocol for infective exacerbations of chronic obstruct ive airways disease (GOAD), specifying the use of oral amoxycillin 500 mg tid (or erythromycin 500 mg qid if allergic) as first line therapy , and oral ciprofloxacin 500 mg bd as second line treatment, was intro duced in 1991. Every third sequential admission was screened for the y ear preceding (1990) and the year after (1991) the protocol was implem ented. Only those patients with a discharge diagnosis of infective exa cerbation of GOAD, but without pneumonia, were included in the analysi s. The two groups (1990 and 1991) were matched in terms of age, sex an d pre-treatment given by their General Practitioner (GP), but differed with respect to severity score, with 1991 being more severe. The outc ome measures showed that duration of hospital stay was comparable as w as duration of treatment. Response to first line therapy was 68% and 6 7% for 1990 and 1991, respectively. Of those who had received antibiot ics from their GP, 67% responded to first line therapy, while of those who had not received antibiotics from their GP 75% responded. Duratio n of therapy was shorter in first line responders (mean and 95% CI: 7. 3 (6.3-8.3) days vs 12.7 (10.1-15.3) days). The mean cost per day anti biotic treatment was reduced by 54.6% (95% CI 52.3-56.9%) from $3.77 t o and $1.71. In conclusion, the introduction of antibiotic prescribing guidelines for treatment of infective exacerbations of GOAD showed no detrimental effect on outcome measures, but was associated with a sig nificant reduction in the cost of antibiotic therapy.