CRP testing in primary care safely cuts antibiotic use in COPD

  • N Engl J Med

  • International Clinical Digest
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

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 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.