CRP testing to guide antibiotic prescribing for COPD exacerbations

For patients with acute exacerbations of chronic obstructive pulmonary disease (COPD), the use of point-of-care testing of C-reactive protein (CRP) to guide antibiotic prescribing may reduce patient-reported use of antibiotics and clinician prescribing of antibiotics, according to new research.

For patients with acute exacerbations of chronic obstructive pulmonary disease (COPD), the use of point-of-care testing of C-reactive protein (CRP) to guide antibiotic prescribing may reduce patient-reported use of antibiotics and clinician prescribing of antibiotics, according to new research. The multicenter study, conducted at primary care clinics in England and Wales, involved nearly 700 individuals with an acute exacerbation of COPD. Patients were randomized to receive usual care guided by CRP point-of-care testing or usual care only, with the primary outcomes patient-reported use of antibiotics for acute exacerbations of COPD within 4 weeks of randomization and COPD-related health status at 2 weeks after randomization. The researchers report that 57.0% of patients in the CRP-guided group reported antibiotic use, compared with 77.4% of the usual-care group. The adjusted mean difference in the total score on the Clinical COPD Questionnaire at 2 weeks was -0.19 points in favor of the CRP-guided patients. Additionally, 69.7% of the usual care group received an antibiotic prescription at the initial consultation, compared with 47.7% in the CRP-guided group, while the rates during the first 4 weeks of followup were 79.7% in the usual care group and 59.1% in the CRP-guided group. Two patients in the usual care group died within 4 weeks of randomization, but the researchers said the causes were unrelated to their trial participation.