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)
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.