Point-of-care testing cuts antibiotic use in COPD

Point-of-care C-reactive protein (CRP) testing leads to reduced antibiotic use in people with acute COPD exacerbations, a study published in The New England Journal of Medicine has shown (11 July 2019)^[1]
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Researchers randomly assigned 653 patients who consulted their GP for an acute COPD exacerbation to usual care or usual care with CRP-testing. GPs were guided that antibiotics should usually not be prescribed for CRP levels below 20mg/L, while they are likely beneficial for levels above 40mg/L.

After four weeks, significantly fewer patients in the CRP-testing group reported antibiotic use compared with the usual-care group (57.0% vs 77.4%). Nevertheless, COPD-related health status on the clinical COPD questionnaire measured at two weeks was comparable between the two groups, suggesting that patient-reported disease-specific quality of life was not compromised.

The researchers explained that primary care point-of-care CRP testing had been shown to reduce antibiotic use in respiratory tract infections, but COPD exacerbations had not specifically been studied.

“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,” they said.