POEMs

Patient-Oriented Evidence That Matters

C-Reactive Protein Guidance Safely Reduces Antibiotic Use in Patients with Acute Exacerbation of COPD

 

Am Fam Physician. 2020 Jan 1;101(1):54.

Clinical Question

Does knowledge of point-of-care C-reactive protein (CRP) level help physicians avoid prescribing antibiotics without sacrificing benefit in patients with an exacerbation of chronic obstructive pulmonary disease (COPD)?

Bottom Line

CRP guidance, regarding the likelihood that antibiotics will be helpful for patients with acute exacerbation of COPD, safely reduces antibiotic use (number needed to treat = 5). Physicians were advised that antibiotics are unlikely to be helpful if the CRP level is less than 20 mg per L (190.48 nmol per L); that antibiotics may be helpful if the CRP level is 20 to 40 mg per L (190.48 to 380.96 nmol per L), especially in the presence of purulent sputum; and that antibiotics are likely to be helpful if the CRP level is greater than 40 mg per L. (Level of Evidence = 1b–)

Synopsis

CRP is an inflammatory biomarker elevated in patients with pneumonia and bacterial rhinosinusitis, and is recommended by United Kingdom guidelines to help physicians avoid prescribing antibiotics in patients with acute lower respiratory tract infection. These authors wondered if the use of CRP would also be effective in patients with an acute exacerbation of COPD. The researchers recruited 653 patients 40 years and older with documented COPD who were experiencing an exacerbation. The patients were randomized to usual care or care guided by the results of a point-of-care CRP test. The guidance provided was that antibiotics are unlikely to be helpful if the CRP level is less than 20 mg per L, that they may be helpful if the CRP level is 20 to 40 mg per L (especially if the patient also has purulent sputum), and that they are likely to be beneficial if the CRP level is greater than 40 mg per L. They were also told that the decision should be guided by all patient factors, not just CRP level. All patients met at least one of the Anthonisen criteria (increased dyspnea, increased sputum volume, and increased sputum purulence). The mean age of patients was 68

POEMs (patient-oriented evidence that matters) are provided by Essential Evidence Plus, a point-of-care clinical decision support system published by Wiley-Blackwell. For more information, see http://www.essentialevidenceplus.com. Copyright Wiley-Blackwell. Used with permission.

For definitions of levels of evidence used in POEMs, see http://www.essentialevidenceplus.com/product/ebm_loe.cfm?show=oxford.

To subscribe to a free podcast of these and other POEMs that appear in AFP, search in iTunes for “POEM of the Week” or go to http://goo.gl/3niWXb.

This series is coordinated by Sumi Sexton, MD, editor-in-chief.

A collection of POEMs published in AFP is available at https://www.aafp.org/afp/poems.

 

 

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