Methodology: 3/5
Usefulness: 2.5/5

Butler CC, et al. N Engl J Med. 2019 Jul 11;381(2):111-120

Editorial: COPD Exacerbations – A Target for Antibiotic Stewardship.

Question and Methods: This was a multicenter RCT to determine if POCT CRP testing vs usual care may help safely reduce unnecessary use of antibiotics.

Findings: Antibiotics were used in 57.0% (CRP) vs 77.4% (usual) of patients; adj. OR 0.31; 95% CI, 0.20 to 0.47. Adjusted mean difference on the COPD Questionnaire was -0.19 points (90% CI, -0.33 to -0.05) favoring the CRP group.

Limitations: Include the availability of CRP-POCT, generalizability to ED population, inclusion of relatively well patients, and absence of CXR.

Interpretation: If CRP-POCT was available, it would best benefit primary care physicians assessing patients with few Anthonisen criteria, to deter them from prescribing an unnecessary antibiotic. It’s currently unlikely to change our practice in the ED.

By: Dr. Alexandre Horobjowsky

Hans Rosenberg
Dr. Rosenberg is an emergency physician at the Ottawa Hospital, assistant professor at the University of Ottawa, and Director of the Digital Scholarship and Knowledge Dissemination Program.