Fingerprick Biomarker Test Can Reduce Use of Antibiotics in COPD Flares

MedicalResearch.com Interview with:

Dr. Chris Butler,, BA MBChB DCH CCH MD FRCGP (Hon)FFPH FMedSci Professor of Primary Care Nuffield Department of Primary Care Health Sciences, Professorial Fellow at Trinity College Clinical Director Primary Care Clinical Trials Unit University of Oxford

Dr. Butler

Dr. Chris Butler,, BA MBChB DCH CCH MD FRCGP (Hon)FFPH FMedSci
Professor of Primary Care
Nuffield Department of Primary Care Health Sciences,
Professorial Fellow at Trinity College
Clinical Director Primary Care Clinical Trials Unit
University of Oxford 

MedicalResearch.com: What is the background for this study?

Response: More than a million people in the UK have COPD, which is a lung condition associated with smoking and other environmental pollutants. People living with the condition often experience exacerbations, or flare-ups, and when this happens, three out of four are prescribed antibiotics. However, two-thirds of these flare-ups are not caused by bacterial infections and antibiotics often do not benefit patients.

A simple finger-prick blood test could help prevent unnecessary prescribing of antibiotics for people with the lung condition chronic obstructive pulmonary disease (COPD).  The finger-prick test measures the amount of C- reactive protein (CRP) – a marker of inflammation that rises rapidly in the blood in response to serious infections. People with a COPD flare-up who have a low CRP level in the blood appear to receive little benefit from antibiotic treatment. The General Practitioner (GP) use of a C-Reactive Protein (CRP) Point of Care Test (POCT) to help target antibiotic prescribing to patients with Acute Exacerbations of Chronic Obstructive Pulmonary Disease (AECOPD) who are most likely to benefit (The PACE Study) determined whether the using a POCT CRP to guide antibiotic treatment decisions for acute exacerbations of COPD reduced antibiotic use without harming patients.

MedicalResearch.com: What are the main findings? 

Response: We found that using a CRP finger-prick blood test resulted in 20% fewer people using antibiotics for COPD flare-ups. Importantly, this reduction in antibiotic use did not have a negative effect on patient’s recovery over the first two weeks after their consultation at their GP surgery, or on their well-being or use of health care services over the following six months. 

MedicalResearch.com: What should readers take away from your report?

Response: Safely reducing the use of antibiotics in this way may help in the battle against antibiotic resistance, while reducing risks to patients from unnecessary antibiotic use.

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: We will soon publish the critically important analysis of the cost effectiveness of using the test in routine care. 

MedicalResearch.com: Is there anything else you would like to add? 

Response: We are grateful to the clinical consultants and patients who contributed to the study, and for the support and vision of the NIHR that has enabled us to bring these  practice changing findings from our trial into the public domain.

See the paper itself for disclosures

Citation:

C-Reactive Protein Testing to Guide Antibiotic Prescribing for COPD Exacerbations

Christopher C. Butler, F.Med.Sci., David Gillespie, Ph.D., Patrick White, M.D., Janine Bates, M.Phil., Rachel Lowe, Ph.D., Emma Thomas-Jones, Ph.D., Mandy Wootton, Ph.D., Kerenza Hood, Ph.D., Rhiannon Phillips, Ph.D., Hasse Melbye, Ph.D., Carl Llor, Ph.D., Jochen W.L. Cals, M.D., Ph.D., et al
July 11, 2019
N Engl J Med 2019; 381:111-120
DOI: 10.1056/NEJMoa1803185

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