CRP-Guided Testing Cuts Antibiotic Use in COPD Exacerbations

For patients with an acute exacerbation of chronic obstructive pulmonary disease (COPD), point-of-care testing of C-reactive protein (CRP) to guide antibiotic prescribing can reduce antibiotic use, according to a study published in the issue of the New England Journal of Medicine.

Christopher C. Butler, from the University of Oxford in the United Kingdom, and colleagues conducted a randomized trial among 653 patients with COPD who consulted a clinician for an acute exacerbation of COPD. Participants were randomly assigned to receive either usual care guided by CRP point-of-care testing (CRP-guided group) or usual care alone (usual care group).

The researchers found that compared with the usual care group, fewer patients in the CPR-guided group reported antibiotic use (57.0 versus 77.4 percent; adjusted odds ratio, 0.31). At two weeks, the adjusted mean difference in the total score on the Clinical COPD Questionnaire was −0.19 points in favor of the CRP-guided group. A significantly lower percentage of patients in the CRP-guided group received an antibiotic prescription at the initial consultation compared with the usual care group (47.7 versus 69.7 percent; adjusted odds ratio, 0.31); the results were similar during the first four weeks of follow-up (59.1 versus 79.7 percent; adjusted odds ratio, 0.30).

"The evidence from our trial suggests that CRP-guided antibiotic prescribing for COPD exacerbations in primary care clinics may reduce patient-reported use of antibiotics and the prescribing of antibiotics by clinicians," the authors write.

Several authors disclosed financial ties to the biopharmaceutical industry.

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