C-Reactive Protein Testing to Guide Antibiotic Prescribing for COPD Exacerbations

Area of Science:

• Primary care research
• Clinical diagnostics
• Respiratory medicine

Background:

• Antibiotic overuse is a concern in managing acute exacerbations of chronic obstructive pulmonary disease (COPD).
• Point-of-care testing (POCT) for C-reactive protein (CRP) offers a potential strategy to guide antibiotic prescribing.
• Reducing unnecessary antibiotic use is crucial to combat antimicrobial resistance.

Purpose of the Study:

• To evaluate the efficacy and safety of CRP-guided antibiotic prescribing for acute COPD exacerbations in primary care.
• To determine if CRP POCT reduces antibiotic use compared to usual care.
• To assess the impact on patient-reported health status.

Main Methods:

• A multicenter, open-label, randomized controlled trial was conducted in 86 general practices in England and Wales.
• 653 patients with COPD exacerbations were randomized to either CRP-guided care or usual care alone.
• Primary outcomes included patient-reported antibiotic use and COPD health status (Clinical COPD Questionnaire) at 4 and 2 weeks, respectively.

Main Results:

• CRP-guided care significantly reduced patient-reported antibiotic use (57.0% vs. 77.4%) and clinician-prescribed antibiotics at initial consultation (47.7% vs. 69.7%) and over 4 weeks (59.1% vs. 79.7%).
• No significant difference in COPD-related health status was observed between groups at 2 weeks (mean difference -0.19).
• No evidence of harm was detected; two deaths in the usual-care group were deemed unrelated to the trial.

Conclusions:

• CRP-guided antibiotic prescribing in primary care for COPD exacerbations effectively lowers antibiotic consumption.
• This strategy demonstrates a favorable safety profile, with no adverse effects on patient health status.
• Point-of-care CRP testing is a valuable tool for optimizing antibiotic stewardship in COPD management.