CRP Testing Reduces Unnecessary Antibiotic Prescribing for COPD Exacerbations

A finger-prick blood test could help prevent unnecessary prescribing of antibiotics for people with chronic obstructive pulmonary disease (COPD). Researchers from the United Kingdom found that the C-reactive protein (CRP) finger-prick blood test resulted in significantly fewer people using antibiotics for COPD flare-ups without negatively affecting patient health.

Throughout the study period, people receiving CRP testing were 20% less likely to be prescribed antibiotics for their exacerbations (57% vs 77.4%).

When people with COPD experience exacerbations, 3 out of 4 are prescribed antibiotics; however, two-thirds of flare-ups are not cause by bacterial infections, so antibiotics will not benefit these people. CRP is a marker of inflammation that rises quickly in the blood in response to serious infection, and low levels of the marker can help indicate who will yield little benefit from antibiotics. WIth rates of antibiotic resistance continuing to climb as a result of medication overuse, safely reducing the use of antibiotics in patients with low CRP levels could help mitigate antibiotic resistance in the patient population.

“Acute exacerbations of chronic pulmonary disease account for considerable proportion of unnecessary antibiotic use, but a good solution to the problem in ambulatory care (where most of the antibiotics are prescribed) has not been identified until now,” Chris Butler, BA, MBChB, DCH, CCH, MD, FRCGP, Hon FFPH, FMedSci, professor of primary care in the Nuffield Department of Primary Health Care Sciences at the University of Oxford, said in a statement.

The researchers collected data from 653 people attending general medicine practices in England and Wales for acute exacerbations of COPD. Patients self-reported their use of antibiotics for COPD flare-ups within 4 weeks following randomization.

At initial consultation, a lower percentage of patients who received CRP testing were prescribed an antibiotic (47.7% vs 69.7%). Similar trends were observed during the first 4 weeks of follow up, with people receiving CRP testing being significantly less likely to be prescribed an antibiotic (59.1% vs 79.7%). Prescribing decisions made by clinicians at the initial consultation were ascertained for all but 1 patient, and antibiotic prescriptions issued over the first 4 weeks of follow-up were ascertained for 96.9% of the patients.

The researchers also documented COPD-related health status at 2 weeks following randomization, which was measured by the Clinical COPD Questionnaire. The questionnaire includes 10 items with scores ranging from 0 to 6, with lower scores indicating better health. The reduction in antibiotic use among people receiving CRP testing did not negatively impact their well-being or use of healthcare services throughout the following 6 months.

Reference:

Butler C, Gillespie D, White P, et al. C-reactive protein testing to guide antibiotic prescribing for COPD exacerbations [published online July 11, 2019]. N Engl J Med. doi: 10.1056/NEJMoa1803185.