TY - JOUR T1 - CRP-guided antibiotic treatment in acute exacerbations of COPD in hospital admissions JF - European Respiratory Journal JO - Eur Respir J DO - 10.1183/13993003.02014-2018 VL - 53 IS - 5 SP - 1802014 AU - H.J. Prins AU - Ruud Duijkers AU - Paul van der Valk AU - Marianne Schoorl AU - Johannes M.A. Daniels AU - Tjip S. van der Werf AU - Wim G. Boersma Y1 - 2019/05/01 UR - http://erj.ersjournals.com/content/53/5/1802014.abstract N2 - The role of antibiotics in acute exacerbations of chronic obstructive pulmonary disease (COPD) is controversial and a biomarker identifying patients who benefit from antibiotics is mandatory. We performed a randomised, controlled trial in patients with acute exacerbations of COPD, comparing C-reactive protein (CRP)-guided antibiotic treatment to patient reported symptoms in accordance with the Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy, in order to show a reduction in antibiotic prescription.Patients hospitalised with acute exacerbations of COPD were randomised to receive antibiotics based either on the GOLD strategy or according to the CRP strategy (CRP ≥50 mg·L−1).In total, 101 patients were randomised to the CRP group and 119 to the GOLD group. Fewer patients in the CRP group were treated with antibiotics compared to the GOLD group (31.7% versus 46.2%, p=0.028; adjusted odds ratio (OR) 0.178, 95% CI 0.077–0.411, p=0.029). The 30-day treatment failure rate was nearly equal (44.5% in the CRP group versus 45.5% in the GOLD-group, p=0.881; adjusted OR 1.146, 95% CI 0.649–1.187, p=0.630), as was the time to next exacerbation (32 days in the CRP group versus 28 days in the GOLD group, p=0.713; adjusted hazard ratio 0.878, 95% CI 0.649–1.187, p=0.398). Length of stay was similar in both groups (7 days in the CRP group versus 6 days in the GOLD group, p=0.206). On day-30, no difference in symptom score, quality of life or serious adverse events was detected.Use of CRP as a biomarker to guide antibiotic treatment in severe acute exacerbations of COPD leads to a significant reduction in antibiotic treatment. In the present study, no differences in adverse events between both groups were found. Further research is needed for the generalisability of these findings.CRP-guided antibiotic treatment (cut-off ≥50 mg·L−1) in patients with acute exacerbations of COPD admitted to hospital significantly reduces antibiotic consumption without an increase in adverse events http://ow.ly/yVxg30nXpQ2 ER -