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Canadian Journal of Infectious Diseases
Volume 14, Issue 5, Pages 254-259
http://dx.doi.org/10.1155/2003/392617
Original Article

Antimicrobials in Acute Exacerbations of Chronic Obstructive Pulmonary Disease - An Analysis of the Time to Next Exacerbation Before and After Implementation of Standing Orders

Rob D Goddard,1 Shelly A McNeil,2 Kathryn L Slayter,1,2 and R Andrew McIvor3

1Department of Pharmacy, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
2Department of Infectious Diseases, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
3Department of Respirology, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada

Received 27 November 2002; Accepted 16 May 2003

Copyright © 2003 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

OBJECTIVE: To compare the mean time to next exacerbation in patients with acute exacerbations of chronic obstructive pulmonary disease (COPD) before and after the implementation of standing orders.

SETTING: Tertiary care hospital, Halifax, Nova Scotia, Canada.

POPULATION STUDIED: The records of 150 patients were analyzed, 76 were in the preimplementation group, 74 in the postimplementation group.

INTERVENTION: The management and outcomes of patients admitted with an acute exacerbation of COPD before and after the implementation of standing orders were compared.

DESIGN: A retrospective chart review.

MAIN RESULTS: There was no difference in the mean time to next exacerbation between treatment groups (preimplementation group: 310 days, postimplementation group: 289 days, P=0.53). Antibiotics were used in 90% of the cases (preimplementation group: 87%, postimplementation group: 93%). The postimplementation group had a 20% increase in the use of first-line agents over the preimplementation group. Overall, first-line agents represented only 37% of the antibiotic courses.

CONCLUSIONS: The implementation of standing orders encouraged the use of first-line agents but did not influence subsequent symptom resolution, length of hospital stay, or the infection-free interval in patients with acute exacerbations of COPD.