Takeaway
- C-reactive protein (CRP) testing by primary care providers to guide treatment decisions reduces antibiotic prescribing and use for COPD exacerbations without compromising health.
Why this matters
- Unnecessary antibiotic use propels antimicrobial resistance, wastes resources, may cause adverse effects, negatively alters patients' microbiome, and distracts from potentially more effective interventions.
Study design
- Multicenter randomised controlled trial (n=653 patients) conducted at 86 general medical practices in England and Wales.
- Patients were randomly assigned to usual care (usual-care group) or usual care guided by CRP point-of-care testing (CRP-guided group) in which providers were advised that antibiotics are unlikely to be beneficial for CRP <20 mg/L, possibly beneficial for CRP 20-40 mg/L, and likely to be beneficial for CRP >40 mg/L.
- Funding: National Institute for Health Research Health Technology Assessment Programme.
Key results
- The CRP-guided group reported less antibiotic use (57.0% vs 77.4% by the usual-care group; aOR, 0.31; 95% CI, 0.20-0.47) and less antibiotic prescribing at initial consultation (47.7% vs 69.7%; aOR, 0.31; 95% CI, 0.21-0.45).
- The CRP-guided group reported better health at 2-weeks posttesting by the Clinical COPD Questionnaire (range, from 0 [very good] to 6 [extremely poor health]; difference, −0.19 [2-sided 90% CI, −0.33 to −0.05] points).
Limitations
- All outcomes patient-reported.
- Open-label design.
References
References
