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Is CRP-guided antibiotic treatment a safe way to reduce antibiotic use in severe hospitalised patients with exacerbations of COPD?

Marc Miravitlles, Carl Llor, Lars Bjerrum, Sanjay Sethi, Antonio Anzueto
European Respiratory Journal 2019 54: 1901405; DOI: 10.1183/13993003.01405-2019
Marc Miravitlles
1Pneumology Dept, Hospital Universitari Vall d'Hebron/Vall d'Hebron Research Institute (VHIR), CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
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  • ORCID record for Marc Miravitlles
Carl Llor
2Research Unit for General Practice and Section of General Practice, Dept of Public Health, University of Copenhagen, Copenhagen, Denmark
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Lars Bjerrum
2Research Unit for General Practice and Section of General Practice, Dept of Public Health, University of Copenhagen, Copenhagen, Denmark
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Sanjay Sethi
3Division of Pulmonary, Critical Care and Sleep Medicine, Dept of Medicine, University at Buffalo, SUNY, Buffalo, NY, USA
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Antonio Anzueto
4Division of Pulmonary Diseases and Critical Care Medicine, School of Medicine, The University of Texas Health Science Center, San Antonio, TX, USA
5Audie L. Murphy Memorial VA Hospital, South Texas Veterans Health Care System, San Antonio, TX, USA
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Extract

We read with great interest the well-conducted clinical trial on C-reactive protein (CRP)-guided antibiotic treatment in admitted patients with acute exacerbations of COPD by Prins et al. [1]. This is a study showing that the use of CRP can potentially assist clinicians in making more prudent use of antibiotics in patients with severe exacerbations, as has also been found in the primary care setting [2]. One of the striking results is, however, the disturbingly high rate of treatment failure observed of approximately 24% at 10 days and 45% at 30 days, as pointed out in the accompanying editorial [3], and consistent with this high rate of treatment failure is a remarkably short time to next exacerbation of less than 1 month [1]. Since the percentage of patients treated with antibiotics in both study groups was very low (31% and 46%), it would be necessary to rule out that the reduction in the use of antibiotics is not responsible for an increase in clinical failures in this population with severe exacerbations of COPD. For comparison, a recent study using CRP to guide antibiotic use in much milder COPD patients in an ambulatory setting resulted in 57% of patients treated with antibiotics [4], in contrast to the 31% antibiotic prescription in CRP guided therapy in severe hospitalised patients in the study by Prins et al. [1].

Abstract

A reduction in antibiotic use to treat COPD must be safe for the patient http://bit.ly/2GxGpTO

Footnotes

  • Conflict of interest: M. Miravitlles reports personal fees for lectures from AstraZeneca, Boehringer Ingelheim, Chiesi, Cipla, Menarini, Rovi, Bial, Zambon, CSL Behring, Grifols and Novartis, personal fees for consultancy from AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Bial, Gebro Pharma, CSL Behring, Laboratorios Esteve, Ferrer, Mereo Biopharma, Verona Pharma, TEVA, pH Pharma, Novartis and Grifols, grants from GlaxoSmithKline and Grifols, outside the submitted work.

  • Conflict of interest: C. Llor reports grants from Abbott Diagnostics, outside the submitted work.

  • Conflict of interest: L. Bjerrum has nothing to disclose.

  • Conflict of interest: S. Sethi reports grants and personal fees from GlaxoSmithKline and AstraZeneca, personal fees from Boehringer Ingelheim, Bayer, Aradigm, Sunovion and Theravance, outside the submitted work.

  • Conflict of interest: A. Anzueto reports personal fees for consultancy from GlaxoSmithKline, AstraZeneca and Boehringer Ingelheim, outside the submitted work.

  • Received July 15, 2019.
  • Accepted July 20, 2019.
  • Copyright ©ERS 2019
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Is CRP-guided antibiotic treatment a safe way to reduce antibiotic use in severe hospitalised patients with exacerbations of COPD?
Marc Miravitlles, Carl Llor, Lars Bjerrum, Sanjay Sethi, Antonio Anzueto
European Respiratory Journal Oct 2019, 54 (4) 1901405; DOI: 10.1183/13993003.01405-2019

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Is CRP-guided antibiotic treatment a safe way to reduce antibiotic use in severe hospitalised patients with exacerbations of COPD?
Marc Miravitlles, Carl Llor, Lars Bjerrum, Sanjay Sethi, Antonio Anzueto
European Respiratory Journal Oct 2019, 54 (4) 1901405; DOI: 10.1183/13993003.01405-2019
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