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.