CRP Testing Reduces Antibiotic Use, Improves COPD Outcomes
Guiding care with C-reactive protein (CRP) point-of-care testing may safely reduce the use of antibiotics among patients who have acute exacerbations of chronic obstructive pulmonary disease (COPD), according to a new study.
For the study, the 653 participants with COPD had consulted a clinician at 1 of 86 general medical practices across England and Wales for an acute exacerbation of COPD.
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The participants were randomly assigned to receive either usual care or usual care that was guided by CRP point-of-care testing. Of those whose treatment was guided by CRP testing, 57.0% reported having used antibiotics for acute exacerbations of COPD within 4 weeks after randomization, compared with 77.4% of the usual care group.
Additionally, during their initial consult with participants, clinicians were less likely to prescribe antibiotics to an individual from the CRP-guided group. About 47.7% of those in the CRP-guided group were prescribed an antibiotic during their initial consultation, while 69.7% in the usual care group were prescribed an antibiotic.
Two weeks after randomization, the researchers measured the participants’ COPD-related health status by administering the Clinical COPD Questionnaire. Those who received care guided by CRP testing reported better COPD health status compared with those who received usual care alone.
The trend in antibiotic prescriptions continued later into the study period, with 59.1% of those in the CRP group and 79.7% of those in the usual care having been prescribed an antibiotic during the first 4 weeks of follow-up.
“CRP-guided prescribing of antibiotics for exacerbations of COPD in primary care clinics resulted in a lower percentage of patients who reported antibiotic use and who received antibiotic prescriptions from clinicians, with no evidence of harm,” the researchers concluded.
—Colleen Murphy
Reference:
Butler CC, Gillespie D, White P, et al. C-reactive protein testing to guide antibiotic prescribing for COPD exacerbations. N Engl J Med. 2019;381(2):111-120. doi:10.1056/NEJMoa1803185.