Antibiotics and steroids for exacerbations of COPD in primary care: compliance with Dutch guidelines.

BACKGROUND The Dutch College of General Practitioners' guidelines specify that antibiotics should only be used for severe cases of chronic obstructive pulmonary disease (COPD). However, GPs tend to administer antibiotics rather than a short course of steroid treatment regardless of severity. AIM The aim of this study was to determine how GPs use current guidelines in treating exacerbations of COPD, in particular whether short courses of oral steroids and antibiotics are prescribed in accordance with the Dutch guidelines for COPD. DESIGN OF STUDY Retrospective analysis of medical records. SETTING Primary healthcare centres. METHOD Medical records of patients registered at four primary healthcare centres in the Netherlands were retrospectively analysed for the period March 2001-March 2003. RESULTS Of 35,589 patients, 1.3% were registered as having a diagnosis of COPD. In 2 years, 47% of the patients had no exacerbation, 35% had one or two exacerbations, and 18% had three or more exacerbations. Of 536 exacerbations, GPs prescribed a short course of oral steroids in 30% of cases, antibiotics in 29%, steroids combined with an antibiotic in 23%, and no oral steroid course or antibiotic was prescribed in 18%. Prescriptions for patients with three or more exacerbations differed significantly from those for patients with one or two exacerbations. CONCLUSIONS Treatment is often not in accordance with current guidelines; in particular, antibiotics are prescribed more often than recommended.