No interests of conflict The study is notified to the Danish Data Protection Agency

1. The use of antibiotics in treatment of acute COPD exacerbations does not adhere to national guidelines Region Sjælland Sygehusapoteket

2. No interests of conflict The study is notified to the Danish Data Protection Agency Clinical pharmacist Marianne Lund Gudik-Sørensen Clinical pharmacist Mie Visby Dyrholm Clinical pharmacist Hanne Nielsen Clinical pharmacist Karen Søgaard Region Sjælland Sygehusapoteket

3. Acute COPD exacerbation is very common in Denmark. Different guidelines for treatment of acute COPD exacerbation in the four regional acute care wards Background Region Sjælland Sygehusapoteket

4. The aims of the study • Investigate which antibiotics, the physicians prescribe in first line treatment to patients with acute COPD exacerbation • Compare the given treatments with national guidelines • Standardize the regional guidelines Region Sjælland Sygehusapoteket

5. National guidelines –Treatment of acute COPD exacerbation Acute care patient: • Cefuroxime 1,5 g iv × 3 Non-acute care patient: • Amoxicillin + clavulanic acid 0,5 g + 0,125 g oral × 3 Patients with penicillin allergy: • Moxifloxacin / Doxycyclin / Macrolides Danish Society of Respiratory Medicine (Dansk Lungemedicin Selskab) Institute for Rational Pharmacotherapy (Institut for Rationel Farmakoterapi) Danish College of General Practitioners (Dansk Selskab for Almen Medicin) Medicin.dk Region Sjælland Sygehusapoteket

6. Methods • 100 patients with COPD randomly selected; 25 from each acute care ward • Data collected retrospectively from electronic charts from August to December 2009 • Prescriptions from one physician could only be included three times • Drug allergies were recorded Region Sjælland Sygehusapoteket

7. Methods Inclusion criteria: • Patients diagnosed with COPD • Age above 18 years • Acute COPD exacerbation treated with antibiotics • Admitted to acute care wards in Køge, Holbæk, Slagelse or Nykøbing F. Exclusion criteria: • No concurrent treatment with chemotherapy or immunosuppressive drugs Region Sjælland Sygehusapoteket

8. Results Data from 100 patient charts were recorded 82 patients received exclusively iv antibiotic treatment Of these: • 73% with cefuroxime (8 out of 10 patients received the recommended dose of 1.5 g x 3) • 27% with benzylpenicillin 17 patients were exclusively treated with oral antibiotics Of these: • 88% with amoxicillin in combination with clavulanic acid • 12% with phenoxymethylpenicillin 1 patient was treated with a combination of • iv cefuroxime and oral azithromycin Region Sjælland Sygehusapoteket

9. Results Region Sjælland Sygehusapoteket

10. Results Region Sjælland Sygehusapoteket

11. Results Region Sjælland Sygehusapoteket

12. Discussion • 60% of all antibiotic treatments were in agreement (drug and dose) with national guidelines • Benzylpenicillin (not recommended) was the second most chosen intravenous treatment New questions: • Was there a reason for choosing cefuroxim 750 mg x 3 for some patients? • Is oral or intravenous penicillin sufficient? Region Sjælland Sygehusapoteket

13. Conclusion The results indicate a need for a regional guideline • The regional guideline should be developed in cooperation with specialists in Infectious Disease, Clinical microbiology and Pulmonary disease • This guideline should result in a “Standard regime” in the electronic health record system (OPUS Medicin) • The aim is to standardize and help the physicians choose the right treatment in the right time! Region Sjælland Sygehusapoteket

14. Thank you for your attention! Region Sjælland Sygehusapoteket