CRP-guided Antibiotic Treatment in acute exacerbations of COPD admitted to Hospital

Introduction the role of antibiotics in acute exacerbations of COPD (AECOPD) is controversial, a biomarker identifying patients who benefit from antibiotics is mandatory. We performed a RCT in patients with AECOPD comparing CRP-guided antibiotic treatment to patient reported symptoms according to GOLD strategy in order to show a reduction of antibiotic prescription

Methods patients hospitalised with AECOPD were randomised to receive antibiotics based according the GOLD strategy or according to the CRP (≥50 mg·L⁻¹) strategy.

Results 101 patients were randomised to the CRP-group and 119 to GOLD-group. Fewer patients in the CRP-group were treated with antibiotics 31.7% versus 46.2% in the GOLD-group (p=0.028) (adjusted OR, 0.178 95%CI 0.077–0.411, p=0.029). Thirty-day treatment failure rate was equal (CRP-group 44.5% versus GOLD-group 45.5%; (p=0.881) (adjusted OR 1.146 95%CI 0.649–1.187 p=0.630) as was time to next exacerbation (CRP-group 32 days, versus GOLD-group 28 days (p=0.713) (adjusted HR0.878 (95%CI 0.649–1.187 p=0.398). Length of stay was similar in both groups (CRP-group 7 days versus GOLD-group 6 days (p=0.206). On day 30 no difference in symptoms score, quality of life or serious adverse events was detected.

Conclusion CRP as a biomarker to guide antibiotic treatment in severe AECOPD leads to a significant reduction of antibiotic treatment. In the present study no differences between both groups in adverse events were found. Further research is needed for the generalisability of these findings

Trial registration clinicaltrials.gov (NCT01232140).