CRP-guided antibiotic treatment in acute exacerbations of COPD in hospital admissions
Journal Club Summary
Methodology Score: 2.5/5
Usefulness Score: 3/5
Question and Methods: The CATCH Study was a multicentre, randomised, controlled open intervention clinical trial comparing CRP guided antibiotics for COPDE vs the Gold Strategy
Findings: The study had a 14.5% AAR in antibiotic use within 24 hours with a NNT of 6.9
Limitations: The major flaw in the study was that the groups were not prognostically balanced due to a poor randomization strategy with block sizes of 50.
Interpretation: This paper provides evidence that CRP may be a useful tool in treating AECOPD, however, CATCH is a small trial with major methodological flaws and currently shouldn’t guide practice.
The NNT concept was created by Canadian Clinical Epidemiologist Dr Andreas Laupacis in 1988 to quantify the benefit of a new intervention. NNT is the average number of patients who need to be treated to prevent one additional bad outcome (e.g. the number of patients that need to be treated for one to benefit compared with a control in a clinical trial). It is easily calculated as the inverse of the absolute risk reduction (1/ARR). The higher the NNT the less effective the treatment. http://www.nejm.org/doi/full/10.1056/NEJM198806303182605
By: Dr. Ian Stiell