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

Butler CC, Gillespie D, White P, et al. N Engl J Med. 2019 Jul 11;381(2):111-120. [CrossRef] [PubMed]

Point-of-care testing of C-reactive protein (CRP) may be a way to reduce use of antibiotics in patients who have acute exacerbations of chronic obstructive pulmonary disease (COPD). The authors performed a multicenter, open-label, randomized, controlled trial involving patients with a diagnosis of COPD. The patients were assigned to receive usual care guided by CRP point-of-care testing (CRP-guided group) or usual care alone (usual-care group). The primary outcomes were patient-reported use of antibiotics for acute exacerbations of COPD within 4 weeks after randomization (to show superiority) and COPD-related health status at 2 weeks after randomization, as measured by the Clinical COPD Questionnaire, a 10-item scale with scores ranging from 0 (very good COPD health status) to 6 (extremely poor COPD health status) (to show noninferiority). A total of 653 patients underwent randomization. Fewer patients in the CRP-guided group reported antibiotic use than in the usual-care group (57.0% vs. 77.4%; adjusted odds ratio, 0.31; 95% confidence interval [CI], 0.20 to 0.47). The adjusted mean difference in the total score on the Clinical COPD Questionnaire at 2 weeks was −0.19 points (two-sided 90% CI, −0.33 to −0.05) in favor of the CRP-guided group. The authors conclude that 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.