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
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Conflict of interest: Dr. Prins has nothing to disclose.
Conflict of interest: Dr. Duijkers has nothing to disclose.
Conflict of interest: Dr. van der Valk has nothing to disclose.
Conflict of interest: Dr. Schoorl has nothing to disclose.
Conflict of interest: Dr. Daniels has nothing to disclose.
Conflict of interest: Dr. van der Werf has nothing to disclose.
Conflict of interest: Dr. Boersma reports grants from GSK, grants from Foreest Medical School, during the conduct of the study.